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Assets All Risk Claim Form
Assets All Risks Claim Form
FOR ALL RISKS, FIRE, MONEY, HOUSE HOLDERS, HOUSEOWNERS BURGLARY, COMBINED, SPECIAL PERILS
BRANCH NO.
(Required)
POLICY NO.
(Required)
THE INSURED
NAME
(Required)
ADDRESS
(Required)
POSTAL ADDRESS
(Required)
OCCUPATION /BUSINESS
(Required)
TELEPHONE NO (BUSINESS)
(Required)
TELEPHONE NO (HOME)
Address at which loss /damage occurred
(Required)
When did the Loss/damage occur?
(Required)
MM slash DD slash YYYY
Describe fully how the loss occurred
(Required)
Have you previously suffered a loss?
(Required)
Yes
No
Full description of previous claims/losses
(Required)
Were the premises occupied at the time of the loss or damage?
(Required)
Yes
No
When was it last occupied
(Required)
MM slash DD slash YYYY
Comments (if any)
How were the premises occupied at the time of loss or damage?
(Required)
Was the loss or damage reported to the police?
(Required)
Yes
No
Why not?
(Required)
Are you the sole owner of the lost or damaged property?
(Required)
Yes
No
Give particulars of other parties involved
(Required)
Is there a bond on the property?
(Required)
Yes
No
Name of Bond Holder
(Required)
What is your estimate value of the entire contents at the time of the loss or damage?
(Required)
Please enter a number greater than or equal to
0
.
What is your estimate value of the entire building(s) at the time of loss or damage?
(Required)
Please enter a number greater than or equal to
0
.
Do(es) the building(s) have a thatch roof?
(Required)
Yes
No
Details
(Required)
Declaration
I agree.
I /We warrant the truth of the answers to the above questions and I/we declare that no information has been withheld and that the amount claimed represents my/our loss arising from the above stated occurrence.
About AFC Holdings
Institutional Overview
Vision, Mission & Values
Board Of Directors
Executive Management
Investments
Tenders
Careers
Commercial Bank
Land & Development Bank
Leasing
Insurance
Media Centre
Press Release
Gallery
News & Updates
