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Claim Form

(Caravans, Off-Road Caravans, Camper Trailers and Motorhome Insurance)
MUST BE COMPLETED AND SIGNED BY THE INSURED, PLEASE COMPLETE ALL SECTIONS IN BLOCK LETTERS

TYPE OF CLAIM

PERSONAL DETAILS (INSURED)

LEISURE VEHICLE DETAILS

REPAIRER

DETAILS OF ACCIDENT/
LOSS/DAMAGE

POLICE REPORT

PREVIOUS
CLAIMS

THIRD PARTY DETAILS

DESCRIPTION OF LOSS/ACCIDENT

LIST OF LOST ITEMS

DECLARATION

I/We the undersigned hereby declare that I/We have completed this Claim Form to the best of My/Our knowledge and ability and that I/We are familiar with the contents hereof. I/we furthermore confirm that I/we have signed the Declaration of my/our own free will and regards it as binding. I/We acknowledge the sharing of information by Insurers is essential to underwrite policies, access risks fairly and reduce fraudulent claims. I/We accordingly consent to any claims information supplied by me on my/our behalf being disclosed to any Insurance Company. I/We further consent that the Insurer may perform a credit search, monitor my’ profile, use the information or data, record my policy payment on the centralised database hosted by ITC.