Insured's last name and initials, or company name
Phone number - Home
Phone number - Work
Insured's Identity Number
Description of loss or damage
Type of claim
Describe fully how the loss or damage occurred
At what location (address) did the loss occur?
The description and value of each item claimed
Was the loss or damage reported to the police?
Please state where you reported the event and to whom (name)?
SAPS Case Number
Please forward a quotation for replacement or repair of item if it is an All Risk claim.
Please complete Captcha Code
Name of Company
Contact Telephone number
When would it be convenient for us to contact you?