Page 166 - claims information pack ebook_e

Section B

Example Claim Form
Claim Number (for internal use only) PART 2 Section B
Property Damage

Summary of your claim

1) Brief description of property damaged and explanation of how damage occurred. Please provide detailed
photographs. Please mark the photographs to indicate the item shown and how this relates to the claim.

2) Are you the sole owner of the damaged property? Yes No
If NO, indicate who owns the property and the nature of the relationship between the applicant and property

3) Description of repairs or cleaning operations performed to the property, or cost of replacement. 21

4) License/registration number (if applicable. e.g. for fishermen)

5) Date(s) on which the repair or cleaning of goods took place or date on which replacement was purchased.

6) Details of normal repair or replacement schedules of property

7) Personnel used, please specify:
a. Number and roles of personnel employed

b.Days/hours worked, daily/hourly rate and overtime rate (specify calculation method, other labour costs, etc)

c. Travel and accommodation expenses for personnel involved in repair or cleaning

d. Summary of costs of food, personal protective equipment, communications, etc. for response personnel