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Lenovo ADP Claim Declaration Form

Manan Sethi filed an insurance claim for damage to his Lenovo ideapad L-340 laptop. On March 16th, 2022 the laptop fell in his home in New Delhi, damaging the screen frame but leaving the internal components working. In submitting this claim, Manan declares the information provided is true and agrees to provide any additional details requested by the insurance company. He understands making false claims would void the coverage and require repayment.

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Manan Sethi
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32 views1 page

Lenovo ADP Claim Declaration Form

Manan Sethi filed an insurance claim for damage to his Lenovo ideapad L-340 laptop. On March 16th, 2022 the laptop fell in his home in New Delhi, damaging the screen frame but leaving the internal components working. In submitting this claim, Manan declares the information provided is true and agrees to provide any additional details requested by the insurance company. He understands making false claims would void the coverage and require repayment.

Uploaded by

Manan Sethi
Copyright
© All Rights Reserved
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

Claim Declaration Form

Claim Type: Insurance claim Date: 21/03/2022

Name of the Customer: ______Manan Sethi_______________________

Contact/MobileNumber: ____9810090004___________________

Service Order/Reference #:_____2005965014_________________

System Serial Number: ___PF28M33T_____________________

Model / Type: _____Lenovo ideapad L-340__________________

Date & Time of the loss / damage: __16th March 2022__________

Place of Incidence:D-58A Freedom fighters enclave,saket,New Delhi

Brief description of the loss / damage:

___The laptop fell down due to which the frame of the screen got damaged, rest the
laptop is working all good.__________________________________________

Declaration:

I / We agree to provide additional information to the company, if required. I /We, the


above mentioned do hereby, to the best of my / our knowledge and belief warrant the
truth of the foregoing statement in every respect, and if l / We have made, or in any
further declaration the company may require in respect of the said loss / damage. If any
of the above is false or fraudulent / any suppression or concealment of details if / when
subsequently discovered, the coverage / protection shall be void for the above
mentioned unit and the company reserves the right to recover the costs in full / part from
me / us. I have/will receive my device repaired/replaced by the authorized service center.

Signature of the customer

Common questions

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An insurance claim declaration should include the claim type, the date of the claim, the name and contact details of the customer, a service order/reference number, the system serial number, the model/type of the product involved, the date and time of loss or damage, and the place of incidence. Additionally, a brief description of the loss or damage should be provided. The declaration should also confirm the customer's agreement to provide additional information if required and the validity of the provided information. The customer must also acknowledge the consequences of providing false or fraudulent information .

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