Thank you for notifying us of your claim.
|
|
|
- Theodore Todd
- 10 years ago
- Views:
Transcription
1 tification Form Once completed, please return your claim form to: Intana Sussex House Perrymount Road Haywards Heath West Sussex RH16 1DN Thank you for notifying us of your claim. Please complete this claim form and return it to Intana as soon as possible. Please write in BLOCK CAPITALS. Please provide full supporting documentation to avoid delays in processing your claim. Company Details (The Assured) Company Name: Company Address: Postcode: address: Telephone Number: Fax Number: Company Contact Name: Claimant Details (The Insured Person) Title Full Name(s) Date of Birth Position Held
2 tification Form Claimant Address: Postcode: Address: Telephone Number: Fax Number: Country of Residence: Certificate Number: Insurance Broker/Employer: Travel destination: Country: Resort: Hotel: Departure Date: Return Date: Purpose of trip: Business / / / / Pleasure If Business: Clerical Manual If Manual please provide details of nature of work:
3 tification Form If your claim is agreed, please complete the payment details below: Bank account (UK bank accounts only): Bank Name: Branch: Bank Sort Code: Account Number: Account Holder: Type of Account (Premier, Gold, Platinum etc):
4 Please confirm the reason for your delayed departure: Please tick confirm this and obtain a letter from the airline to Strike Industrial Action Weather Conditions Mechanical/Technical Other If Other, please provide details: 1. State scheduled date and time of departure: / / : 2. State actual date & time of departure: / / : 3. Number of hours delayed Please confirm if your delay occurred: 4. On your outbound/ return flight from/to your country of residence 5. On a connecting flight 6. Amount Claimed Missed Departure/ Journey Continuation Please confirm the reason for your missed departure: Please tick box: Accident/ electrical or mechanical breakdown Exceptional/ Unforeseen traffic conditions Other If Other, please provide detail: Report obtained from the appropriate authority confirming reason for missed departure provided (i.e. Highway Agency, breakdown recovery) Please list expenses incurred in reaching your booked destination: Expenses claimed i.e. Flight / Train / Ferry / Accommodation Expenses claimed Receipts/ Invoices supplied Office Use Only
5 Do you hold any form of bank account/ credit card that offers you complimentary travel insurance that cover the circumstances surrounding your claim? If YES, please confirm the following: Card number: Issuing Bank: Card Type (Gold, Platinum, Premier): Has a claim to a third party been submitted? If YES, please provide details: Is there any other relevant policy that may cover the circumstances surrounding your claim? Other policies, Barclaycard, Amex If YES, please provide details: If the claim is in relation to injury please confirm the following: 1. An outline of the circumstances giving rise to the accident
6 2. If a third party was involved the name and address of the Third Party and their insurance details if known 3. In the event that you are pursuing a claim for damages against a Third Party please provide the name and address of any solicitor who may have been appointed and their reference number 4.If no Third Party was involved please clarify who or what was at fault and why If your claim is agreed, please provide your banking details below for payment: Confirm payee name: Bank Name: Bank Address: Bank SWIFT Code: Bank IBAN: Account Number: Sort Code: Account Holder:
7 Type of Account (Premier, Gold, Platinum etc): DECLARATION IMPORTANT Failure to sign will result in your claim form being returned. I/we declare that the above statements are true and correct to the best of my/our knowledge and belief. I/we have not withheld any information within my/our knowledge connected with this claim. I/we agree to provide the insurer with any further information as may be reasonably required. I/we understand that the insurer does not admit liability by issue of this form. WARNING the making of a fraudulent or knowingly exaggerated claim is a criminal offence. We investigate all cases and any person suspected of fraud is reported to the police with whom we always co operate. DATA PROTECTION ACT The insurance industry operates a number of anti fraud initiatives. The information given on this form may be stored electronically and may be shared with other organisations for this purpose. I/we understand that you may ask for information from other organisations to check the answers I/we have provided. IMPORTANT In the event of a third party being liable, all rights in this matter are subrogated to the travel insurance underwriters or their agents on all settlements of this claim. Signature: Date: / /
Notification Claim Form
Notification Claim Form Once completed, please return your claim form to: Intana Sussex House Perrymount Road Haywards Heath West Sussex RH16 1DN Thank you for notifying us of your claim. Please complete
To enable us to review your claim, we require completion of the enclosed Claim Form together with the appropriate documentation detailed below:
To enable us to review your claim, we require completion of the enclosed Claim Form together with the appropriate documentation detailed below: Full details of your planned travel itinerary. A letter from
Notification Claim Form
Notification Claim Form Once completed, please return your claim form to: Intana Sussex House Perrymount Road Haywards Heath West Sussex RH16 1DN Thank you for notifying us of your claim. Please complete
TRAVEL DELAY, MISSED DEPARTURE ABANDONMENT, PISTE CLOSURE
D TRAVEL DELAY, MISSED DEPARTURE ABANDONMENT, PISTE CLOSURE 1 Tower View Kings Hill, West Malling Kent ME19 4UY Tel: 0845 370 7187 Fax: 0870 620 5001 Email: [email protected] Web: www.tif-plc.co.uk
We enclose for your completion the necessary paper work for us to consider your claim.
7-8 DUCKETTS WHARF - SOUTH STREET - BISHOPS STORTFORD HERTS - CM23 3AR TELEPHONE: 01279 713860 Accident & Health Claims Services 7 8 Ducketts Wharf South Street Bishop s Stortford Hertfordshire CM23 3AR
Travel Guard Claims PO Box 60108 London, SW20 8US Tel: 0845 603 9892* Fax: 0870 130 1950
Travel Guard Claims PO Box 60108 London, SW20 8US Tel: 0845 603 9892* Fax: 0870 130 1950 Dear Sir / Madam, So that we may process your claim as quickly as possible please ensure that you fully complete
Personal Accident Or Illness Claim Form
Once completed, please return your claim form to: Intana Sussex House Perrymount Road Haywards Heath West Sussex RH16 1DN Thank you for notifying us of your claim. Please complete this claim form and return
We are writing further to your request for a claim form and are very sorry to note the circumstances described.
InsureandGo Claims PO Box 5775 Southend-on-Sea Essex SS1 2JY Dear Sir / Madam, TRAVEL INSURANCE CLAIM We are writing further to your request for a claim form and are very sorry to note the circumstances
We are writing further to your request for a claim form and are very sorry to note the circumstances described.
PO Box 5775 Southend-on-Sea Essex SS1 2JY Dear Sir/Madam Travel Insurance Claim We are writing further to your request for a claim form and are very sorry to note the circumstances described. In order
INSURANCE CLAIM FORM
INSURANCE CLAIM FORM This purpose of this document is to help you complete your insurance claim. Please read the instructions below and carefully follow them, this will enable us to complete the assessment
Travel Guard Claims PO Box 60108 London, SW20 8US Tel: 0845 603 9892* Fax: 0870 130 1950
Travel Guard Claims PO Box 60108 London, SW20 8US Tel 0845 603 9892* Fax 0870 130 1950 Dear Sir / Madam, So that we may process your claim as quickly as possible please ensure that you fully complete and
...making travel insurance easy
Dear Sir/Madam, We understand that you need to make a claim on your travel insurance policy. To ensure we can assess and finalise your claim as quickly as possible and to avoid unnecessary delays, please
Travel Claims Form STEP 1 CLAIM FORM COMPLETION REQUIREMENTS STEP 2 CLAIMANT DETAILS. Policy and Claimant Details. A. Travel Arrangements
STEP 1 CLAIM FORM COMPLETION REQUIREMENTS Please read and complete this form. Please retain a copy of ALL documents for your records. Documents in a foreign language are required to be translated into
Motor Accident Claim Form
Motor Accident Claim Form Agricultural Commercial & Private Vehicles www.towergateunderwriting.co.uk Guidance Notes Most delays in settling claims arise because claim forms are not fully completed or requested
Details of the 3rd party or their representative you feel is responsible for the injury.
Bupa Travel Insurance Claims AIG Travel PO Box 60108 London SW20 8US Tel: 0330 123 1910* Fax: 0870 130 1950 Dear Sir / Madam So that we may process your claim as quickly as possible please ensure that
When we receive your claim submission, we will assess it and correspond with you further in due course.
Travel Insurance Boots Travel Claims PO Box 60108 London SW20 8US Tel: 0845 125 3820 Fax: 0870 130 1950 Dear Sir / Madam, So that we may process your claim as quickly as possible please ensure that you
CHECKLIST OF DOCUMENTS REQUIRED. DOCUMENTATION SHOWING YOUR TRAVEL DATES AND FULL COST OF THE TRIP (booking invoice)
PA PERSONAL ACCIDENT Dear Customer, Travel Claims Facilities 1 Tower View Kings Hill, West Malling Kent ME19 4UY Tel: 0845 370 7187 Fax: 0870 620 5001 Email: [email protected] Web: www.tif-plc.co.uk
We are writing further to your request for a claim form and are very sorry to note the circumstances described.
InsureandGo Claims PO Box 5775 Southend-on-Sea Essex SS1 2JY Dear Sir / Madam, TRAVEL INSURANCE CLAIM We are writing further to your request for a claim form and are very sorry to note the circumstances
Motor Accident Claim Form
Motor Accident Claim Form Agricultural Commercial & Private Vehicles www.towergateunderwriting.co.uk Guidance Notes Most delays in settling claims arise because claim forms are not fully completed or requested
Expiry Date. If you have selected Cheque please nominate payee
TRAVEL INSURANCE CLAIM FORM IMPORTANT: PLEASE READ BEFORE YOU COMPLETE THIS FORM 1. Please answer all questions and provide all relevant documentation to avoid delays with your We are unable to process
We are writing further to your request for a claim form and are very sorry to note the circumstances described.
PO Box 5775 Southend-on-Sea Essex SS1 2JY Dear Sir/Madam Travel Insurance Claim We are writing further to your request for a claim form and are very sorry to note the circumstances described. In order
OSG Travel Claims, PO Box 1086, Belfast, BT1 9ES Email : [email protected] Tel: 020 7581 6444 Medical - Claim Form
OSG Travel Claims, PO Box 1086, Belfast, BT1 9ES Email : [email protected] Tel: 020 7581 6444 Medical - Claim Form CLAIM No:- For Office Use Only OSG Travel Claims are committed to providing a
MOTOR ACCIDENT REPORT (NOT FOR USE ON THEFT CLAIMS OR MOTOR TRADE)
Insurance Company Limited MOTOR ACCIDENT REPORT (NOT FOR USE ON THEFT CLAIMS OR MOTOR TRADE) First Response Claims Line 0845 373 1300 Fax 020 7068 7740 Email [email protected] www.tradex.com Policyholder
We are writing further to your request for a claim form and are very sorry to note the circumstances described.
InsureandGo Claims PO Box 5775 Southend-on-Sea Essex SS1 2JY Dear Sir / Madam, TRAVEL INSURANCE CLAIM We are writing further to your request for a claim form and are very sorry to note the circumstances
How To Claim From Safari Safari Insurance In Korea
Date sent to us: / /20 Claim Reference Number (if known): Please answer all relevant questions on the claim form. Leaving items blank, using ticks, dashes and n/a may result in us returning the claim form
Travel Claim Form. E mail Address: I.D. Card No. Age. Occupation Name of Employer. Telephone No. Home: Mobile: Business:
Return this form together with all necessary documents to: GasanMamo Insurance, Msida Road, Gzira GZR 1405 Malta For any queries please call 21 345 123 ext 5 Travel Claim Form Branch/Broker/TII Claim Number
Email. Name of Intermediary (if any) Gender Male Female Age Date of Birth D D / M M / Y Y Y Y. Date of Employment D D / M M / Y Y Y Y.
TRAVEL INSURANCE Claim Form *SG021* *SG021* TO FACILITATE THE PROCESSING OF YOUR CLAIM, YOU ARE REQUIRED TO COMPLETE SECTIONS A, B AND C FOR ALL CLAIM SUBMISSIONS. The issue and acceptance of this form
TRAVEL INSURANCE CLAIM FORM
TRAVEL INSURANCE CLAIM FORM Claims Enquiries call: +(60) 3 6207 4115 or 1 800 806 377 (within Malaysia) E-Mail: [email protected] Mail: MHinsure Claims Level 14, Tower B, Dataran
Travel Insurance Claim Form
CLAIMAINTS DETAILS Policy Number Departure Date Return Date Title First Name Surname ID / Passport Number Email Address Mobile Number Business Contact No Home Contact No Fax No Postal Address Postal Code
Motor Assistance Claim Form
Please complete this claim fully and return to us by following the postal instructions below. For ERV.co.uk, ERV Express, Planet Earth, Eurocamp, Keycamp, Select Sites, Axiom, Cyclosure, starttravel.co.uk
Travel Claim Form Cancellation, alteration, disruption or delay
GlobeCover Personal Accident & Travel Insurance Travel Claim Form Cancellation, alteration, disruption or delay GlobeCover Personal Accident & Travel Insurance The claimant should complete and sign this
Travel Insurance Claim Form
Travel Insurance Claim Form for BNZ Credit Cards 1 TRAVELLER details Please print your details clearly in CAPITAL letters using a pen Traveller (MrMrsMsMiss) Telephone Homework ( ) Mobile ( ) Email Address
Title Given name/s Surname Date of birth. Postal address Suburb State Postcode
NRMA Claim Form For assistance call: 1300 135 640 Submit your claim to NRMA Insurance by: Post: NRMA Insurance Claims, Claims Department Private Bag 913, North Sydney NSW 2059 Fax: (02) 9202 8098 Email:
Please print out for signatures and post original to your broker if applicable or to AIG Insurance New Zealand Limited.
Corporate Travel Insurance Claim Form Please print out for signatures and post original to your broker if applicable or to AIG Insurance New Zealand Limited. Corporate Policies Only: This section MUST
COMMERCIAL VEHICLE INSURANCE PROPOSAL
Tradewise Insurance Services Ltd COMMERCIAL VEHICLE INSURANCE PROPOSAL SUMMARY OF COVER This is a brief outline only - a copy of the policy wording including all terms and conditions may be obtained on
ACCIDENT CASH PLAN- HOSPITALISATION CLAIM FORM
ACCIDENT CASH PLAN- HOSPITALISATION CLAIM FORM Please provide as much information as possible when completing this form. If you are unable to fit your answers into the spaces below, please continue on
Making a claim with Suresave
Making a claim with Suresave Before you start In order for us to process your claim quickly it s important that you complete all the relevant sections of this form with as much detail as you can If you
AVANT TRAVEL INSURANCE CLAIM FORM
AVANT TRAVEL INSURANCE CLAIM FORM IMPORTANT: PLEASE READ BEFORE YOU COMPLETE THIS FORM 1. Pleas e answer all questions and provide all relevant doc umentation to avoid delays with your claim. We are unable
LIABILITY CLAIM GUIDANCE NOTES
LIABILITY CLAIM GUIDANCE NOTES In the unfortunate event of a claim, we will do everything possible to deal with your claim promptly. In respect of claims made against you by any third party, for damage
CLAIM FORM. Bank Medical aid name Company Description. Bank:
1. Personal details CLAIM FORM 2nd Floor, 288 Kent Avenue Randburg Johannesburg P O Box 3337, Cramerview 2060, South Africa DX 147 Randburg Tel: +27 (0)11 521-4000 Fax: +27 (0)11 521 4420 Email: [email protected]
LIABILITY CLAIM GUIDANCE NOTES
insuring the UK s triathletes LIABILITY CLAIM GUIDANCE NOTES In the unfortunate event of a claim, we will do everything possible to deal with your claim promptly. In respect of claims made against you
Claim Form TRAVEL INSURANCE
ACCIDENT & HEALTH INTERNATIONAL Claim Form TRAVEL INSURANCE Sydney Level 4, 33 York Street Sydney NSW 2000 GPO Box 4213, Sydney, NSW, 2001 T: +61 2 9251 8700 F: +61 2 9252 4385 ABN: 26 053 335 952 AFS
Making a claim with TID
Making a claim with TID Before you start In order for us to process your claim quickly it s important that you complete all the relevant sections of this form with as much detail as you can If you do not
Corporate Travel Claim Form
Corporate Travel Claim Form Important Notice The acceptance of this Form is NOT an admission of liability on the part of Zurich Insurance Company Ltd (Singapore Branch) (the Company ). Any documentary
Singapore Airlines Claim Form
Singapore Airlines Claim Form IMPORTANT NOTE: Please answer all questions contained in this claim form as leaving items blank, using ticks, dashes and N/A may make it necessary for us to return your claim
2. For cancellation or amendment of travel arrangements due to you or your relatives illness /death (Complete Sections A, C D and E)
IMPORTANT: please read this before you start Use the check list below to help you complete your claims form, and identify you will need to attach. We don t want you to miss something. Delays can occur
Making a claim with COTA
Making a claim with COTA Before you start In order for us to process your claim quickly it s important that you complete all the relevant sections of this form with as much detail as you can If you do
Claim Form Travel Insurance
United Overseas Insurance Limited 3 Anson Road #28-01 Springleaf Tower Singapore 079909 Tel: (65) 6222 7733 Fax: (65) 6327 3869 / 6327 3870 Email: [email protected] uoi.com.sg Co. Reg. No. 197100152R Claim
Citibank Travel Insurance Claim Form
ACE Insurance Limited ABN 23 001 642 020 AFSL. 239687 Level 1, 51 Berry Street rth Sydney NSW 2060 Australia PO Box 403 rth Sydney NSW 2059 Australia 1800 305 422 (02) 8912 9704 (02) 9231 3697 +61 2 8912
PERSONAL ACCIDENT BENEFITS CLAIM FORM
PERSONAL ACCIDENT BENEFITS CLAIM FORM Please note that we have to ensure that our claim form covers all types of claims. If you do not consider a question to be relevant to your circumstances please enter
EMPLOYERS LIABILITY CLAIM FORM
EMPLOYERS LIABILITY CLAIM FORM Insured Insured Policy Number Postcode Type of Business VAT registered? Yes No Annual Turnover Non-clerical wage roll Contact Please provide details of the person we should
ORCHESTRALGUARD LIABILITY CLAIM GUIDANCE NOTES
insuring the UK s orchestral musicians ORCHESTRALGUARD LIABILITY CLAIM GUIDANCE NOTES In the unfortunate event of a claim, we will do everything possible to deal with your claim promptly. In respect of
Public / Employer Liability Claim Form
Public / Employer Liability Claim Form www.towergateunderwriting.co.uk Guidance Notes Most delays in settling claims arise because claim forms are not fully completed or requested documents are not sent
IMPORTANT INFORMATION
ACE JERNEH INSURANCE BERHAD (formerly known as Jerneh Insurance Berhad) (9827-A) Claim Services Department, Level 26 Menara Weld, 76 Jalan Raja Chulan, 50200 Kuala Lumpur, Malaysia 1800 88 2846 Tel 03
QBE Trade Credit Trade Credit Insurance proposal form
QBE Trade Credit Trade Credit Insurance proposal form QBE European Operations Please read the following information carefully This document sets out the important information that you, or your insurance
Corporate Travel and Personal Accident Insurance Claim Form
Claim : Corporate Travel and Personal Accident Insurance Claim Form Prepared 03 January 2012 Email: [email protected] Phone: 1800 761 173 Facsimile: (07) 3360 7854 Postal Address: Claims
Travel Insurance Claim Form
Travel Insurance Claim Form 1 TRAVELLER details Please print your details clearly in CAPITAL letters using a pen Policy Number Name of Traveller (Mr/Mrs/Ms/Miss) Name of Policy Owner Telephone Home/work
Phillips House 12 Church Street Harwich Essex CO12 3DS Phone: 01255 553039 Fax: 01255 240560 Email: [email protected]
Personal Accident Claim Phillips House 12 Church Street Harwich Essex CO12 3DS Phone: 01255 553039 Fax: 01255 240560 Email: [email protected] 1 What Should I do Now? Please ask your doctor to complete the
CLAIM FORM - EQ TRAVEL. Section 1 - Particulars of Insured. Section 2 - Details of Incident/Loss/Illness (must be completed)
CLAIM FORM - EQ TRAVEL Agency: Policy No.: Please note: Sections 1, 2 and 12 must be completed. Sections 3 to 11 complete only the relevant sections. The acceptance of this form is NOT an admission of
Claim Form Travel Insurance
United Overseas Insurance Limited 3 Anson Road #28-01 Springleaf Tower Singapore 079909 Tel: (65) 6222 7733 Fax: (65) 6327 3869 / 6327 3870 Email: [email protected] uoi.com.sg Co. Reg. No. 197100152R
Making a claim for compensation against Renfrewshire Council. Information and Claim Pack
Making a claim for compensation against Renfrewshire Council Information and Claim Pack You must read these terms before completing the Public Liability Claim Form 1. If you make a claim through your own
For all claims the following documents must be sent to us along with this claim form:
IMPORTANT: please read this before you start Use the check list below to help you complete your claims form, and identify documents you will need to attach. We don t want you to miss something. Delays
Personal accident Claim form
1 January 2015 Personal accident Claim form Please complete clearly in BLOCK CAPITALS. Are you submitting this claim as a scanned copy? Yes No Further information about how to complete this form can be
Australia Post Claim form
Australia Post Claim form How do I make a claim with Australia Post? You can make your claim with Australia Post in 3 simple steps: 1 Fill out the claim form Please look at the below table to see which
MOTOR TRADE CLAIM FORM
Insurance Company Limited MOTOR TRADE CLAIM FORM First Response Claims Line 0845 373 1300 Fax 020 7068 7740 Email [email protected] www.tradex.com Policyholder s Name Company Name Policy No. (cover note
Personal Property and Money Claim Form Loss, Damage or Delay (Temporary Loss)
Personal Property and Money Claim Form Loss, Damage or Delay (Temporary Loss) Lifeline Plus Group Personal Accident & Travel Insurance The claimant should complete and sign this form. If the claimant is
Travel Insurance Claim Form
Jetstar Travel Travel Insurance Insurance Claim Form IMPORTANT NOTE: Please answer all questions contained in this claim form as leaving items blank, using ticks, dashes and N/A may make it necessary for
CURTAILMENT OF A TRIP
C CURTAILMENT OF A TRIP Travel Claims Facilities 1 Tower View Kings Hill, West Malling Kent ME19 4UY Email: [email protected] Web: www.tif-plc.co.uk Dear Customer, In order that we can process your
BRITISH GYMNASTICS PERSONAL ACCIDENT CLAIM FORM
W Denis Insurance Brokers PLC BRITISH GYMNASTICS PERSONAL ACCIDENT CLAIM FORM Brigade House 86 Kirkstall Road Leeds LS3 1LQ Telephone: 0113 243 9812 Fax: 0870 705 2085 Email: [email protected] ONCE
Multi-Platform Open Annuity
Multi-Platform Open Annuity Application Form Powered by the London & Colonial... Upgradable, Capable, Flexible www.londoncolonial.com Multi-Platform Open Annuity Form To London & Colonial Assurance PLC:
QBE travel insurance claim form
QBE travel insurance claim form QBE Insurance (Australia) Limited ABN 78 003 191 035 AFSL 239 545 Office use only Claim number Please answer all questions and tick boxes where appropriate Leaving a question
PPI Claim Form. Easy steps to claim back your money. 1. Fill in all the required details and questionnaire.
PPI Claim Form Easy steps to claim back your money. 1. Fill in all the required details and questionnaire. 2. Sign and date the Terms of Service and Letter of Authority where you see the Joint policies
Liability Claims Guidance Notes
Liability Claims Guidance Notes It is important that you read and understand these guidance notes before When can a claim be made against the Council? completing the claim form To successfully claim compensation
FEDERAL INSURANCE COMPANY One of the Chubb Group of Insurance Companies
FEDERAL INSURANCE COMPANY One of the Chubb Group of Insurance Companies 18 Cross Street #11-08 China Square Central Singapore 048423 Telephone: 6333 8113 Facsimile: 6333 8112 Unique Entity No. S83FC3361G
Motor Accident Report Form
Completing the claim form It is always important to notify your Insurer of a claim as soon as possible after an accident has occurred. Please therefore complete this form and return it to us within 14
Important notice each incident requires a separate claim form. Postal Address Risk/Cost Centre
Travel Claim Form 221 St George s Terrace, Perth GPO Box K837 Perth WA 6842 Telephone (08) 9264 3333 Facsimile (08) 9322 1557 Website www.riskcover.wa.gov.au Important notice each incident requires a separate
www.healthcareinternational.com
REVOLUTIONISING TRAVEL INSURANCE www.healthcareinternational.com Welcome to HealthCare International As a specialist provider of private medical and related personal insurances, we have the experience
Bridging Loan Application Form
t e w +44 (0)20 3397 7055 [email protected] Bridging Loan Application Form Section 1: Introducer Details Introducer name: Introducer company: Telephone no: Email address: Mobile no: As the Introducing
Motor Trade Road Risks. Proposal Form
Motor Trade Road Risks Proposal Form PLEASE ANSWER ALL QUESTIONS FULLY IN BLOCK CAPITALS If there is insufficient space for any answers please continue on the back page 1. PROPOSER Mr Mrs Miss Ms Surname
Name of Traveller Mr Mrs Miss Ms. For prompt settlement please attach original or photostat copy of Insurance Certificate
The provision of this form by AIG is not an admission of liability or acceptance by AIG of your claim. All questions in this section must be answered Name of Traveller Mr Mrs Miss Ms Occupation: Date of
Making a claim against North Lanarkshire Council. Guidance Notes - Liability Claim Form
Making a claim against North Lanarkshire Council Guidance Notes - Liability Claim Form It is important that you read these guidance notes before completing your claim form These are the terms and conditions
Are you registered for GST? Yes No. To what extent are you entitled to claim an Input Tax Credit on the GST applicable to the premium?
Public Liability Claim Form Note: The issue of this claim form is not admission of liability on our part. All questions must be fully answered. Please print clearly and tick the appropriate boxes to indicate