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  • All Risks Claim Form

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    Dominic Huni
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    This document is an all risks claim form from an insurance company for a credit purchase. It requests information about the insured purchaser, date and details of the loss or damage, and requires attached documents like the credit application, invoice, police report, and repair invoices. The purchaser must declare if they have other insurance and sign that all information provided is true and correct.

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    This document is an all risks claim form from an insurance company for a credit purchase. It requests information about the insured purchaser, date and details of the loss or damage, and requires attached documents like the credit application, invoice, police report, and repair invoices. The purchaser must declare if they have other insurance and sign that all information provided is true and correct.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    11 views1 page

    All Risks Claim Form

    Uploaded by

    Dominic Huni
    This document is an all risks claim form from an insurance company for a credit purchase. It requests information about the insured purchaser, date and details of the loss or damage, and requires attached documents like the credit application, invoice, police report, and repair invoices. The purchaser must declare if they have other insurance and sign that all information provided is true and correct.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    igi Insurance

    Real people. Real confidence

    Bard House, 69 Samora Machel Avenue


    Box UA262 K.Nkurumah Ave, Harare
    Tel: 04-705221-7/727294-8
    Fax: 04-705228/727299

    CREDIT PURCHASE

    ALL RISKS CLAIM FORM

    Credit Store Insurance Certificate No


    Address Schedule Date
    __

    Name of Purchaser
    Address ____________

    Period of Agreement _____ Months Sum Insured $

    Date of loss/Damage Time


    Police Station Reported Crime Ref No

    NB: The under listed documents must be attached to this claim form : - (Tick attached documents)

    1) Copy of the credit application form


    2) Copy invoice
    3) Statement of account from inception of agreement
    4) Copy of police report ( theft )
    5) Replacement/Repair invoice (damage )
    Description of loss or damage ( to be completed by purchaser )

    Do you have any other Insurance Policy ? Yes/No ,If so state Insurer

    I/We hereby declare that to the best of my/our knowledge, all information, statements and particulars
    pertaining to this document are true and correct.

    Signed
    Purchaser For Credit Store

    Date

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