Insurance Claim Report

INSURANCE INCIDENT REPORT

PROPERTY LOSS/DAMAGE
(Property Damage--Fire, Water,
Structural, etc.)Theft of Personal Property

A. Location of Loss, Including City & Province B. Date and Time of Loss

Johannesburg, Gauteng, 2190 25 February 2024

17:30

C. Description of Loss
1 Kind of Loss Fire Lightening Flood Other
Theft X Hail Wind
2 Description of Loss -- (Use separate sheet if necessary):

ASUS VivoBook 15” Notebook – S/N: R8N0LP01C55632E

SANSUI 58” LED TV – S/N: SLEDS-58UHDA
XIAOMI TV Box (2nd Gen) – S/N: 40152/800001141584
ROYAL Homeware Air Fryer – S/N: AF20535M
Panasonic Compact Stereo System – S/N: MM3GA001498
SAMSUNG A04 32gb – S/N: R58W91J6C4K

D. Name/Address of Contact Person

Ntombozuko Elbigina Mahapa
Name: Surname:
754 Oakdene Parks, Stanley Park
Address:
Johannesburg, Gauteng, 2190
City, Province:

Phone Number: +27 82 466 6038 Fax Number: N/A

E. Police Contacted Yes No Fire Department Contacted Yes No

F. Reported by
Ntombozuko Elbigina Mahapa
Name: Surname:

Signature: Date:

MiWay is an authorized FSP (45741), distributing and servicing long term insurance products - T’s & C’s apply
Insurance Claim Report

Dear Customer

I am writing with reference to your ASUS VivoBook Notebook.

Below unit has been reported at our Claims Service Center and SAPS.

Report Number : SS003178

Description : ASUS VivoBook Notebook 15"

Serial Number : R8N0LP01C55632E

SAPS Case Number: 634/02/2024

We have determined that your unit has been blocked due to theft.

Should you require any additional information, please feel free to contact us at

claims@miway.co.za

Kind Regards
MiWay Claims Center

MiWay is an authorized FSP (45741), distributing and servicing long term insurance products - T’s & C’s apply
Insurance Claim Report

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MiWay is an authorized FSP (45741), distributing and servicing long term insurance products - T’s & C’s apply