Household Claim Form Broker/Bank/Intermediary name Name (of Policyholder) Policy Number Postal Address of Policyholder Your Name Content limited to 80 characterserror-wrapper, remaining: 80 Your Email address Your Phone number Date of Incident E.g., 03-11-2024 Location of incident Incident circumstances Has the house become uninhabitable due to the incident? YesNo Description of lost/damaged property Estimated cost of repair/replacement Content limited to 100 characters, remaining: 100 Further details Content limited to 250 characters, remaining: 250 Image attachments to be submitted Allowed types: jpg jpeg gif png bmp heic.Allowed types: jpg jpeg gif png txt doc xls pdf ppt pps odt ods odp. Allowed types: jpg, jpeg, gif, png, bmp, heic. CAPTCHA Math question 1 + 1 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. To prove you are not a robot, solve this simple math problem and enter the result You can read our full Data Protection Notice here. Please indicate that you have read and understood this Notice. This data once submitted, cannot be directly amended by you at a later point. A Claims handler will be in contact to discuss your claims notification, as per the inputs you have supplied.
