Professional Documents
Culture Documents
for Communication
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National
Insurance
Company
Ltd.
071
'ALL
1. The completed claim form should
RISKS'
CLAIM
FORM
Office of the Company within 7 days
be returned
to the Issuing
of its receipt. 2. 3. A list of all lost and damaged The Company does not admit property liabilitv must be furnished hy issuing this form. in the space provided overleaf.
Policy Claim
No. No.
Tel. No
1.
was the
missing
property
2. or damage discovered? On what day and at what 3. State the circumstances Full particulars hour was the loss of must the loss
or
damaged.
be given.
4.
the
Police If
been date
loss? Police
Station
5.
a)
search
been
made
for
b)
to
recover
the property?
6.
Is
the
Claimant
the
sale
owner
of
the
property
loss or damaged?
7.
8.
sustained
other
losses particulars.
of
9.
If
claim
is
in
respect
of
jewellery,
when
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was the property last overhauled by a Jeweller? Name and address of the Jeweller should be stated.
2.
I do articles kind, I do hereby lost affirm and declare with that the above true given statements and the statements contained in the list of of any or damaged are in all respects the particulars that and complete and are made without reservation
and declare
to my knowledge mortgagee,
than
by bill
of sale or as owner,
or otherwise,
and that
there
are no other
by me or so far as I am aware,
by any other
person.
Date:
Sinnature
of Claimant
LIST
All claims but not depreciation must be based exceeding the upon the sums for
OF ARTICLES
actual which value
LOST
OR DAMAGED
at the insured time of the Theft, due allowance Loss or Damage, being made for
of the articles
and wear and tear. From wh jI j i or by V"v I I I (Receip should b I perusa tear P. Rs. Rs. claimed tion for I wear Cost received ! ! and Date or DeducpurchaAmount I sed Rs.
\
or Vouchers Jm presented attached return) for lm purchased Item No.~and I Full description I of in the articles lost or Schedule damagedI I of Policy
..
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SVP/500/7/96