Prepare your insurance claim

Property loss claim form for your insurance

Owner’s information

Full name *

Address *

Postal code *

City *

Date of birth *

Item’s information

Description *

Location *

Date of loss *

Identifying details* Describe all relevant identifying details of the item such as make, model, serial number and so forth.

Estimated value *

I have reported this loss to the police

The item is insured *

I declare that the information above has been filled out truthfully *