Home Insurance

Important, please read before you start to fill in the form…

Is the property insecure – ie damage to locks / doors / windows
Is there standing water in the property – ie flooding
Is there ongoing dripping / leaking water
Is there sewage / mud contamination
Is there risk of injury – ie risk of falling masonry or electrocution
Is the Property uninhabitable
Yes

All fields marked with a * are mandatory.

About you

What is your first name? * :

What is your surname? * :

And are you...(find out who can claim) * :

What is your preferred telephone number? * :

What is the best time to contact you? * :

Morning
Afternoon
Evening
No preference

What's your email address? * :

Please confirm your email address? * :

What's your policy number? * :

About your claim

What is the full address of the property covered under your policy?*:

Postcode * :

House number/name * :

street name * :

Town/City * :

County :

When did this incident happen? (dd/mm/yyyy) * :

Where did this incident happen? * :

At home
Away from home

Were the police involved? * :

Please let us know about the circumstances of your Claim* Give a brief description of what happened and what has been damaged ( max Characters 2000). * :

About the damage to your house

This section only applies if you are claiming for damage to your home

How many rooms are affected? * :

Where is the damage to your building? * :

Item	Age (year)	Where purchased	Value	Proof of ownership

Image Upload

Image upload

You can upload images you have of the damage to your property or electronic copies of receipts etc as proof of ownership / loss:

The images should be under 500Kb in size.

Upload 1 :

Upload 2 :

Upload 3 :

Upload 4 :

Upload 5 :

Anything else

Please let us know anything else about your claim circumstances which may help us to deal with your claim more effectively?: (max characters 800) :

home claims notification form

Important, please read before you start to fill in the form…

About you

About your claim

About the damage to your house

This section only applies if you are claiming for damage to your home

Image upload

Anything else

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