C CLAIMS

Form of Instruction

 

Insurer    Claim number:    Contact 

Address      Tel No.    Fax  No.  

Email            

 

 

Policyholder:     Daytime Tel No   Mobile Tel No

Address:     Home Tel No  Fax No

E mail:

 

 

Claim type:      If Other Details

Location of incident:  Date of incident: 

Location of inspection/enquiry  

Reserve:   Sums insured:

Policy type:     Special conditions: 

 

 

Identity of repairers (if any): Tel:  Fax

Address     

E mail 

Estimated costs

 

 

If theft Police office involved:Crime reference:

Police Tel no

 

 

Identification details of stolen/missing property:  

 

If collision/accident: Witness details:

Name:  Daytime tel no   Fax no

Mobile tel no

Address    

E mail

 

 

Other instructions:

This instruction  is considered legally binding and electronically signed when sent to C Claims by clicking the Submit button.

 

                        

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