Online Claim Form

To ensure your claim is dealt with as quickly as possible, please complete this 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 fo repair e.g. following theft the Claims Administrators will instruct our authorised supplier to arrange replacement to comply with general conditions 2 (basis of settlement) of the Certificate.
Please note that we act on behalf of the Insurance Company on any claim.

WARNING: If in the course of claim validation, misrepresentation of the facts is discovered we will consider this as fraud. Details of all such cases will be passed to the appropriate agencies for action.

Details

Policy Number *
Title *
First Name *
Last Name *
Company/School *
Address *
Telephone - Work
Telephone - Home
Telephone - Mobile
E-mail
Who was in charge of the equipment when damage occured:
How the damage occurred:
Date and time when the damage occurred:
Location of where the damage occurred:
Date, Time and by whom the damage occurred:
What damage has occurred:
Who was in charge of the equipment when the theft occured:
Date and Time the theft occurred
Location where the theft occurred:
Date and time when it was discovered:
Do your suspicions rest on anyone? If so, on whom?
Date, time and location when the property was last seen:
In all cases the Police must be advised within 24 hours. Please state: Name of Police Station, Tel No of Police Station, Date Reported, Police Crime Number *
Full description of property damaged or stolen *
Is there any other insurance covering the property concerned
1. Yes
2. No
If you answered yes to the above question please supply details
Are you a taxable company for VAT purposes?
1. Yes
2. No
If yes, you can recover the value added tax which will be included in the cost of repairing or replacing the property for which you are claiming? If not, please state % and reason in the field below.
% and reason
Declaration *

* Indicates required fields.

Lapsafe IT Insurance. Phone: 0845 230 1010

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