NFRN Mutual Limited - a better alternative to conventional insurance companies

Property claim form -

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Member details

Full name*
Contact person
Phone*
Fax
Email
NFRN Member No
Is your business VAT registered (Commercial claims only)YesNo
Fields marked * are required.

Details of Event

Date of Event
Time of event
Where did the event occur?
Is any Third Party to blame for the loss or damage? If so, give name and address
Brief Description of loss or damage

Claims for loss by BURGLARY, THEFT or MALICIOUS DAMAGE

Method of Entry
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
Have Police been notified? If so, give station, date and crime reference if known.

Details of Loss

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

Damage to property

Description of property and scope of damage	Name of repairer	Cost of repairs	Delete item
	Amount Claimed£0

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.
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.

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