All Risks Claim Form

(the company does not admit liability by the issuance of this form)
Name of Policyholder
Policy No
Contact Person
Tel No
Address of the Premises at which the loss occurred
Date Of Loss
Describe fully how the loss or damage occurred
Have the police been advised or other enquires made (Please attach Police report)
Do any other person/s interest in lost property
If Yes, Please specify

Do you have any other existing insurance
that refer to the property herein mentioned?
If Yes, Please specify

Have you ever suffered similar loss/damage? If so, provide details of claim.
If the loss is by fire, can it be repaired? Please state
 the total amount claimed as set out in detail overleaf.
Details of Amount Claimed
A) If claim is for repairable damage, give particulars of damage and a tradesman's estimate for the repairs.
B) If claim if for non repairable damage on loss, list items below completing all columns. Supporting estimates for replacement may be helpful.
Specifications of
Lost / destroyed
Cost Price Where bought &
Date Purchased
Value at time of loss
Declaration: I/We hereby declare that these particulars are true to the best of my/our knowledge and belief and I/we have in no manner caused the loss nor by any fraud or misrepresentation sought to benefit thereby. I accept that insurers would be at liberty to deny liability in part or in full if the above written answers are false or inaccurate in any aspect.

Please note that all personal information provided to TMiS is subject to the Personal Data Protection Policy Statement posted at under privacy statement.