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All Risks Claim Form for Insurance

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.

Uploaded by

Dominic Huni
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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12 views1 page

All Risks Claim Form for Insurance

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.

Uploaded by

Dominic Huni
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

igi Insurance

Real people. Real confidence

Bard House, 69 Samora Machel Avenue


Box UA262 [Link] 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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