Afrikaans | English
 

General Claim Form

General Claims Information

General Claim Form

  • Policy number

  • Insured's last name and initials, or company name

  • Email Address

  • Phone number - Home

  • Phone number - Work

  • Cellphone number

  • Insured's Identity Number

  • Description of loss or damage

  • Date

  • Time

  • Type of claim

  • Describe fully how the loss or damage occurred

  • At what location (address) did the loss occur?

  • City

  • Province

  • Postal code

  • The description and value of each item claimed

  • Was the loss or damage reported to the police?

  • Date Reported

  • 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.

  • Attachment Upload

  • Max. file size: 100 MB.
  • This field is for validation purposes and should be left unchanged.