CompuCover - insurance for a mobile generation

To ensure your claim is dealt with as quickly as possible, please complete this claim form in full.

Your claim will be delayed if you do not complete ALL relevant sections. All claims must be referred to the Claims Administrators before you take any action. Failure to do so will invalidate your claim.

For a claim that is not capable of repair e.g. following theft, the Claims Administrators will instruct our authorised supplier to arrange replacement.

The claim form will need to be completed in full by the named Policyholder. If the Policyholder requires someone else to complete the form on their behalf, then due to the Data Protection Act we will need the name and address of the person who will complete the form on the Policyholder's behalf. This information will need to be provided by the Policyholder in writing either by post, fax or e-mail.

Fields marked with an * are mandatory.

PLEASE DO NOT SEND YOUR EQUIPMENT TO US

1 - YOUR DETAILS

2 - CLAIM TYPE
Is the claim for - * Complete sections 3, 5, 6, 7 and 8
  Complete sections 4, 5, 6, 7 and 8

3 - THEFT CLAIMS



4 - DAMAGE CLAIMS (Please ensure all data is backed up prior to collection of your equipment)





When the incident occurred was the item in a case?:*     


5 - OTHER INSURANCES


6 - VAT STATUS
Are you a taxable organisation for VAT purposes and can you recover VAT?:*     
If yes, the VAT element of the cost of repair or replacement will be invoiced directly to you by the company authorised to fulfil your claim.

7 - DECLARATION
The details you supply will be used to administer your claim and to combat fraud. The above answers to the questions will be the basis of the assessment of your claim.

All material facts must be disclosed. A material fact is one that is likely to influence us in the assessment or acceptance of this claim, or one that is likely to influence our consideration of cover under the terms of your policy. If you are in any doubt as to whether a fact is material, you must disclose it.

I/We submit my/our claim for the amounts stated and declare that, to the best of my/our knowledge and belief, all information given on this form is true and correct, as will be my/our response to any further enquiries made by CompuCover.
PLEASE ENSURE YOU COMPLETE THE EQUIPMENT DETAILS BELOW

8 - DETAILS OF ITEMS STOLEN OR DAMAGED
Item Make* Model* Serial Number
and/or IMEI*
Description Date
Purchased*
Where
Purchased*
Purchase Price
(inc. VAT)
1
2
3
4
5
6
7
8
9
10

 
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TO KEEP YOUR PREMIUMS LOWER  -  WE TAKE ACTION AGAINST INSURANCE FRAUD