Telephone 01274 465500
Email info@tldallas.com
HOME
ABOUT US
SERVICES
OUR GROUP
NEWS
MAKE A CLAIM
CAREERS
CONTACT US
MENU
Commercial insurance
Personal insurance and high net worth insurances
Trade credit insurance
Travel insurance
Health and care insurance
Books and collectables insurance
Farming and agriculture insurance
Specialist avian influenza (AI) insurance
Demolition contractor insurance
Education insurance
Due diligence services
Claim consultancy
Risk management
Independent financial services
Dallas Scott Davey Ltd.
Dallas Wilding Drew Ltd.
TL Dallas (NI) Ltd.
Bradford
Cumbria
Edinburgh
Falkirk
Glasgow
Holmfirth
London
Shetland
Stockport
Commercial property claim form
Particulars of claim
Please complete fully and submit so that your Insurers can consider your claim.
1. Your policy details
Name of policyholder
Policy / Certificate number
Telephone
Email
Full address and postcode of policyholder
Are you VAT registered?
Yes
No
Are you responsible for the property being claimed?
Yes
No
If no enter the detail of who is
2. Information about your claim
Date of incident
Time of incident
Date of discovery
Time of discovery
Discovered by
Address of where incident took place if different from above
Full details of circumstances
Were the premises occupied at the time of the incident?
Yes
No
Are the premises protected by an alarm?
Yes
No
Did the alarm operate?
Yes
No
Is there CCTV?
Yes
No
Was the incident reported to the police?
Yes
No
If yes details of the police station and officer
Crime reference number
3. If the incident involved a third party, please provide
Name of the third party
Address of the third party
Vehicle registration
Insurer and poilcy number
Please provide details of any witnesses
Name
Address
4. Details of property being claimed.
Property 1
Date of purchase
Original purchase cost
Replacement Cost (supply written estimate)
Value of salvage
Amount claimed net of VAT
Upload Estimates/Receipts wherever possible to avoid delays
Insurers tend to issue settlement by BACS, please provide bank details which should be used in the event a payment is agreed
Bank
Sort Code
Account Number
To whom should a cheque be made payable to?
I/We have the authority to complete and submit this claim on behalf of the policyholder.
I/We declare that the above information is true and complete to the best of my/our knowledge.
Full name
Position
Signature
Date
Send