Property claim form - Household cover
Member details
  7. YesNo
  8. Fields marked * are required.
Details of Event
  1. Date of Event
  2. Time of event
  3. Where did the event occur?
  4. Is any Third Party to blame for the loss or damage? If so, give name and address
  5. Brief Description of loss or damage
Claims for loss by BURGLARY, THEFT or MALICIOUS DAMAGE
  1. Method of Entry
  2. The extent to which the premises/items were protected from loss or damage at the time of the occurrence, eg.alarm, cctv, locks, or any other security
  3. Have Police been notified? If so, give station, date and crime reference if known.
Details of Loss
  1. Loss of property
    Description of property for which loss is claimed Serial No's of items Current Replacement Cost Value of salvage
    (if any)    		 Date of purchase or acquisition Amount of loss or damage claimed
    Delete item
    Amount Claimed£0
  2. Damage to property
    Description of property and scope of damage Name of repairer Cost of repairs
    Delete
    item
    Amount Claimed£0
  3. NOTE:
    (1) Tax Invoices for repairs or replacement must be posted to us.
    (2) Where an item of equipment must be replaced, and you propose to replace that item with:
    - The same brand of equipment, but a different model; or
    - A different brand of equipment You must indicate whether the replacement equipment is the equivalent of, or better or more extensive than, the equipment it is replacing.
  4. Additional information
Declaration
I, ... being a Member and on behalf of the Member declare the above answers to be true and correct and acknowledge that NFRN Mutual may make its decision to exercise discretion to grant protection having regard to these answers.
Accept
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