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Claim Reporting Form


Please Provide following details and you will be contacted on first working day after the date of your claim intimation. However, this is not an admission of liability under the policy. The claim will be processed in accordance with terms, conditions, exceptions and limitations of the relevant Insurance Policy

Policy #    
Date of Loss  
Location of Loss  
Brief Description of Loss:  
Material Damage

Personal Injury / Sickness
If material damage, where a survey can be conducted:  
If personal injury/sickness, Name of Hospital:  
Contact Information:  
Email Address:    


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