Wedding Insurance Claim Form

General

Insured(Required)

Policy Number(Required)

Contact Number(Required)

Email Address(Required)

Wedding Date(Required)

DD slash MM slash YYYY

Loss Details

Date of Loss(Required)

DD slash MM slash YYYY

Time of Loss(Required)

Hours

Minutes

AM/PM

Cause of Damage / Loss (Full Description)(Required)

Property Loss or Damage

Property Loss or Damage(Required)

Yes

Police Station and Case Number (If Applicable)

Other Insurance(Required)

Yes

Deatils (If Applicable)

Other Interests Noted

Preliminary Required Documentation(Required)

Proof of Ownership

2 x Replacement / Repair Quotes

Proof of Damages / Damage Report / Videos / Photos (If Applicable)

Possible Liability to Third Parties

Possible Liability to Third Parties(Required)

Yes

Do you Believe You Were Negligent?(Required)

Yes

Please Elaborate on The Above(Required)

What measures were taken, if any, to mitigate the loss?(Required)

Third Party Name(Required)

Third Party Contact No(Required)

Details of Injury or Damaged Property(Required)

Witness Name

Relationship To Insured

Witness Contact No(Required)

Witness Email(Required)

Required Documentation

Contractual Agreements (If Applicable)

Replacement / Repair Quote/s

Proof of Damages (If Applicable)

3RD Party Statement

Proof of Insurance

Cancellation / Curtailment / Rescheduling

Yes

Is the event cancelled, curtailed or Rescheduled?

Comprehensive statement setting out the circumstances of the claim in chronological order

During what point of the wedding event did you conclude that the event must be cancelled / discontinued?

Who decided that the wedding event must be cancelled / curtailed / rescheduled? (E.g Insured, event organizer, authorities etc.)

Written statement of person or entity of who cancelled the event

Required Documentation

Contractual Agreements (If Applicable)

Expenses incurred / financial document (Indicate VAT Inc. or VAT Ex

Proof of Damages (If Applicable)

Insured Banking Details

Bank(Required)

Branch Code(Required)

Name of account holder(Required)

Account No(Required)

Declaration

Declaration

I / We warrant that the answers given are true and correct and that no information has been withheld in respect of the loss. All details provided on this form are done so honestly and in good faith. This mean that the Insurer has been made aware of all important information and that any incorrect information may mean that the claim may be rejected, and the policy voided.

I / We confirm that I / We understand, consent and agree that the Insurer and its agents will collect, share, store and process my/our information for insurance and/or insurance related purposes only.

Signature(Required)

Capacity(Required)

Today's Date

DD slash MM slash YYYY

Statement of Losses Being Claimed

PLEASE NOTE THAT INSURERS MAY REQUEST FURTHER PARTICULARS DURING THE VALIDATION OF THE CLAIM.

STATEMENT OF LOSSES BEING CLAIMED REQUIRED.

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

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Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Full Description

Amount Claimed

Name

This field is for validation purposes and should be left unchanged.

Claim Form

General

Loss Details

Property Loss or Damage

Possible Liability to Third Parties

Cancellation / Curtailment / Rescheduling

Insured Banking Details

Declaration

Statement of Losses Being Claimed

Contact us

Address

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