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 Insurance claim enquiry form
Insurance claim enquiry form.
Please provide the following information which will help us to deal with your enquiry.

Name *
Address
Telephone *
Email
What type of loss have you suffered?
Fire
Theft
Water Damage
Other; please give details below.

What value do you estimate your claim to be?
#3,000 - #10,000
#10,000 - #50,000
in excess of #50,000

Have your insurers admitted liability?
Yes
No
Claim refused; please give details below.

Have you submitted a claim to your insurers or their Adjusters?
Yes, in writing
Yes, verbally
No

Comments / Details of claim:

* required


Members of the Institute of Public Loss Assessors.  Authorised and regulated by the Financial Conduct Authority.
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