We have made our claims process as straightforward as possible to ensure that you are reunited with your repaired or replacement equipment as quickly as possible. Therefore 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.

Fill in a claim online or download our claims form PDF below

    1. Your Details (Individual and/or organisation submitting the claim)

    Title*

    Name*

    Surname*

    Organisation (if applicable)

    Address

    Postcode*

    Contact Number (9am-5pm)*

    Email*

    Policy Number*

    Date Insurance Purchased*

    2. Claim Type

    Is the claim for - *

     Theft (Complete sections 3, 5, 6, 7 and 8) Damage (Complete sections 4, 5, 6, 7 and 8)

    3. Theft Claims

    Date of theft

    Time of theft

    Date theft discovered

    Time theft discovered

    Date when equipment was last seen

    Time when equipment was last seen

    Who was in charge of the equipment when the theft occurred?

    Where did the theft occur?
    HomeSchool, college etc.WorkTravellingOther

    Please provide further details, e.g equipment stolen from the lounge

    How did the theft occur?

    Where were you located when the theft occurred?

    If the theft was from your premises or vehicle, how was access gained? (please provide as much details as possible)

    Date reported to the police

    Time reported to the police

    Police references

    Police station address including postcode

    Police station telephone number

    Name of the individual who you reported the theft to

    4. Damage Claims

    Date of incident

    Time of incident

    Date of discovery

    Time of discovery

    Who was in charge of the equipment when the incident occured?

    What type of incident occured? (tick all that apply)
    Dropped equipmentFell whilst carrying equipmentFire damage to equipmentHeat damage to equipmentItem fell on equipmentItem shut inside equipmentKnocked off furnitureKnocked out of handsLiquid spillageNo incident took placePet damagePower surge to equipmentSat on equipmentSmoke damage to equipmentStood on equipmentOther (please give details)

    Where "other" has been selected, please provide details

    What type of damage occurred? (tick all that apply)
    Casing damageCracked screenDamage to portsEquipment in piecesEquipment not chargingEquipment scratchedEquipment will not startLiquid spillage to keyboardLiquid spillage to screenScreen display affectedOther (give details)

    Where "other" has been selected, please provide details

    How did the incident occur? (please provide as much detail as possible)

    Where were you located when the incident occurred?

    Name of any person excluding the claimant, who you feel is responsible for the incident

    Did anyone else witness the incident?
    yesno

    If yes, please provide their name and contact details

    When the incident occurred was the equipment in a case?
    yesno

    If yes, please provide make and model

    5. Other Insurances

    Do you have any other insurance that may cover this incident?*
    YesNo
    Please provide the insurance company and policy number

    6. VAT Status

    Are you a taxable organisation for VAT purposes and can you recover VAT?*
    YesNo

    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 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 tick the box to confirm you have read the declaration*

    Please ensure you complete the equipment details below

    8. Details of items stolen or damaged

    Item 1

    Make*

    Full Model Description*

    Colour

    Serial Number and/or IMEI*

    Date Purchased*

    Where Purchased*

    Purchase Price (inc. VAT)

    + Item 2

    Make*

    Full Model Description*

    Colour

    Serial Number and/or IMEI*

    Date Purchased*

    Where Purchased*

    Purchase Price (inc. VAT)

    + Item 3

    Make*

    Full Model Description*

    Colour

    Serial Number and/or IMEI*

    Date Purchased*

    Where Purchased*

    Purchase Price (inc. VAT)

    + Item 4

    Make*

    Full Model Description*

    Colour

    Serial Number and/or IMEI*

    Date Purchased*

    Where Purchased*

    Purchase Price (inc. VAT)

    + Item 5

    Make*

    Full Model Description*

    Colour

    Serial Number and/or IMEI*

    Date Purchased*

    Where Purchased*

    Purchase Price (inc. VAT)

    9. Additional Information

    If you have any additional information that will assist us with your claim, please include details below