CLAIM FORM

PLEASE READ THE NOTES CAREFULLY BEFORE COMPLETING THE FORM

B & L Underwriting use a limited number of specialist Loss Adjusters. We want to give you the best service possible at the time when you most need our help but we cannot do this unless you give us all the information we need to process your claim. Please therefore answer all the questions as fully as you can. We have tried to cover most insured eventualities with these questions but please add further relevant information in the blank square provided.

ADVISORY NOTES

Questions 1 to 6 / The information enables us to quickly find your file and establish that the Certificate is in force. It helps if you print the answers as handwriting can sometimes be difficult to read and delay ensues. We need your telephone number so that an Adjuster or other representative can make rapid contact with you if needed.
Question 7 / Most Insurance policies/Certificates including yours, contain conditions which either say that the “more specific Insurance” shall pay or alternatively that where both apply they shall share the loss in proportion to their sums Insured. We may ask you to make a claim under the other Policy/Certificate but where possible we deal directly with the other Insurer thereafter.
Question 8 / Your Certificate normally covers your own personal property and that of permanent members of your household living with you, it also covers items like TV sets on hire for which you are legally responsible.

GENERAL QUESTIONS

(Answer these whatever type of claim you are making)

1. / I am claiming under Certificate no: Renewal date:
2. / Name of Insured:
3. / Occupation:
4. / Address in UK:
5. / Situation where claim occurred:
6. / Date and time of occurrence:
7. / Is the property lost or damaged insured by an other Insurer? YES/NO (If YES please give details)
8. / Policy no:……………………….
Type of insurance:………………………………………
Insurer:……………………………………………………
Are you the sole owner of the property lost or damaged? YES/NO (If NO please give details).
Name of Owner…………………………………………..
Relationship to you……………………………………….
Does he/she normally live at your home YES/NO / MOST IMPORTANT
HOW DO WE CONTACT YOU?
Address…………………………………………
……………………………………………………
……………………………………………………
Telephone no:…………………………………
When?……………………………………………
Any Comment?……………………………….
9. / Have you claimed under this or any other Policy/Certificate before? YES/NO
If YES, please state:
(i)Date of Loss……………………………….
(ii)Type of Loss……………………………….
(iii)Amount Paid……………………………..
10. / Are the premises Owner Occupied/Tenanted/Unoccupied/Holiday Home/Other
(Please delete what is not applicable)
11. / a) Are you Registered for VAT? YES/NO
b) If so, give number and state the amount you can recover:

ADVISORY NOTES

As well as establishing that an insured loss has occurred we need to work in closely with Police to try to apprehend any criminal involved and to recover your property. With some malicious damage (such as occurs during riots or civil disorder), you are entitled to recompense from the Police Authority itself.

Do remember to look at the Definitions listed in the Certificate as you cannot claim for scorching or melting or singeing unless there is actual flame and unless frost is the direct cause of the burst or leak you cannot claim for damage to tanks, pipes or apparatus when they burst or leak, only for the resultant damage to other property.

The Certificate does not cover lack of maintenance so be sure that any weather damage claimed for is the direct result of storm or tempest and not just because the Property needed repair. If repair to the Building is going to result in considerable improvement then expect your claim to be reduced accordingly as the aim of insurance is to leave you neither better nor worse off after the claim.

Always try to obtain at least two estimates for repair and do not go ahead with repair unless you do to prevent further damage. All Insurers like to see the damage for themselves before repair is effected.

If your Business Equipment, Stock or other Contents are damaged by any peril tell your Broker at once so that he can contact us. You may well need help in the shape of an experienced Adjuster to guide you on cleaning or drying out etc. Do not throw away damaged articles until we settle your claim or advise you to dispose of them unless keeping them is a danger to health.

LOSS OF OR DAMAGE TO PROPERTY

a) / Name of claim (tick appropriate box)
Fire  Lightning  Explosion  Aircraft 
Theft  Storm  Flood  Malicious 
Accidental  Accidental  Any other  Impact 
Damage Loss
b) / Please give details:
As precisely as possible, state what happened:
c) / Who discovered the loss or damage?
(If someone other than yourself – relationship to you i.e. tenant etc)
d) / When did they discover it?
e) / Were the premises occupied at the time of loss of damage? YES/NO
If Unoccupied, how long for?
f) / Have you obtained any estimates for repair or replacement? YES/NO
If YES, please enclose them
Please give your estimate of the likely overall amount of claim £
h) / If the cause of claim was Theft or Malicious Damage at the premises:
i) Was the occurrence reported to the Police? YES/NO
ii) Who reported it?
iii) To which Police Station?
iv) Crime Number Allocated:
v) Immediately prior to a break-in, were all the doors locked and the windows properly secured
and alarm if any operative? YES/NO
If NO, please explain:
vi) Did loss or damage occur by forced entry? YES/NO
vii) Do you suspect anybody? YES/NO
If YES, please give details:
viii) What steps have you taken to try and recover the property?
ANY ADDITIONAL INFORMATION TO ASSIST UNDERWRITERS

I/We warrant the truth of all information given on this claim form

Insured’s Signature______

Date______

B & L Underwriting Agencies Ltd, 1st Floor, Peek House, 20 Eastcheap, London EC3M 1EB

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