E-Claim Please advise us of any claims or incidents that may arise and kindly complete the preliminary loss advisory form below.We will be in contact with you and start working on your claim immediately to ensure fair and swift settlement Insured name:Policy number:Email Address: Phone number:Mobile number:Type of loss:Date of loss: DD slash MM slash YYYY Name of person reporting loss: First Last Address Line 1:Address Line 2:Parish:Name of any injured parties: First Last Owner of property damaged: First Last Description of loss:
