ZURICH Property eClaim Form

The easiest method of submitting your claim is to complete the claim form below and hit the submit button at the bottom of the page. This will send your claim to the appropriate department automatically and we will be in contact in due course.

You can also print this form out but you will need to set the page layout to landscape before you print and send it to the correct contact address which is detailed on the contact us page on the menu bar.

For all material damage loss – general properties, housing, theft, computer, money and all risks

  1. Claims for buildings and property that is capable of repair should be supported by a contractors estimate/invoice.
  2. Claims for items that require replacement should be supported by a suppliers estimate/invoice for the equivalent replacement(s)
  3. In the case of computer losses, we require confirmation that the replacement equipment is of the same specification, or the nearest equivalent.

INSURED

Organisation Name

Policy Number

Zurich Claim Number

Your reference


DETAILS OF CLAIM

Date of Incident

Time of Incident

For gradually occurring damage such as subsidence, please state exposure period

From

To

Department

Type of property damaged or lost

Use of Premises

Cause of Damage

Description of Loss

Were the Premises occupied at the time?

If No, when were they last occupied?

Are you the sole owner of the property lost or damaged?

If No, give details of any other person interested.

Is there any other insurance covering the loss?

If Yes, give details.


LOCATION OF INCIDENT

Address

Postcode


OTHER PARTIES

Have you any reason to suspect that the loss arose through the negligent actions of any particular person?

If Yes, Name:

Full Address (including Post Code)

Vehicle Registration Number

Insurer (if applicable)


ADDITIONAL CLAIM DETAILS

Building
Description of loss/damage and estimate of cost.

What sort of construction are the premises?

Who discovered the loss?

Fire
Where did the fire start?

What was the main factor that assisted the spread of the fire?

Contents
Description of article

When and where purchased? (Please attach receipts if available)

Price Paid(£)

Value of Salvage
(if any)(£)

Amount Claimed (i.e replacement cost net of any salvage)(£)

 

Total Amount Claimed (£)


Please complete the section below for THEFT/MONEY claims only.

Where was the property taken from ( e.g. Building, From person).

If from a building what was the point of entry ?

For MONEY losses, please details whether being used for petty cash, wages, rent collection etc.

Full description of the circumstances, including details of the locked safe/receptacle in which the item/money was kept, what force was used or from where the keys/combination were obtained. If the item/money was lost in transit how was it being carried and what security was in place ?

What precautions have been taken place to prevent a reoccurrence of a similar incident ?


POLICE DETAILS

Were the Police advised of the loss?

If yes Date and Time

Name of officer to whom reported

Station


ANY ADDITIONAL INFORMATION WHICH MAY BE RELEVANT AND DECLARATION

by submitting this completed form I declare that all answers are true and correct to the best of my knowledge and belief.

Additional Information

Customer Specific Data

By Submitting this form I declare that all answers are true and correct.

 

 

Contact Name

Job Title

Address

Postcode

Email Address

Phone Number

Are you VAT registered?

What Percentage recovery can you make from customs and excise ?