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CLAIM FORM Please complete this form in as (London Institute of Management and Technology)

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THM Claim Form: JAN2019
CLAIM FORM
Please complete this form in as much detail as possible and send to us. You can also print it out and complete and return to
TH March at the address shown at the end of the form. If you complete the form by hand and have insufficient space in the boxes
provided please use a separate sheet of paper and attach to the claim form.
Please note failure to give full details could lead to the settlement of the claim being delayed.
Policy Number
PERSONAL DETAILS
Full name (Mr/Mrs/Miss/Other)
Address
Post Code
Occupation:
Home Telephone:
Daytime telephone:
E-mail:
Are you happy for us to contact you by e-mail regarding your claim? YES NO
DETAILS OF LOSS/DAMAGE - Please give all details requested to avoid delay
Date
Time
When was this discovered and by whom?
Where did loss/damage occur?
Circumstances and cause of loss/damage
Are you the sole owner of the property claimed for? YES NO
If NO please state name(s) of other interested parties and the nature of their interest.
If a loss or theft, when was it reported to the police and by whom?
(Please note ALL claims involving loss or theft, without exception, must be reported to the local police)
Date
To which police station
Telephone Number
Incident/Crime Report Number
THM Claim Form:0119
If lost or stolen from a premises or a vehicle where were the items left and how was access gained? Were any protective devices in
operation at the time?
Please advise what enquiries or steps have been made to recover the items lost and details of steps taken to prevent a similar loss
taking place.
PREVIOUS LOSSES
If you have suffered previous losses or damage arising from any risk insured under this policy please give details below
OTHER INSURANCES
Is the property being claimed for covered by any other policy? YES NO
If ‘Yes’, please give details below.
Insurer
Policy Number
Renewal date
DETAILS OF CLAIM
Notes:
1. Damaged property should never be disposed of until permission has been given by the Underwriters.
2. In the case of repairable damage please submit detailed estimates before work is carried out.
3. Wherever possible provide receipts or other documentary evidence showing date and price of purchase of lost or damaged
articles.
Description of property lost, destroyed
or damaged
Purchase Date
Cost Price
Residual Value
Repair or
Replacement
Net amount
claimed
1.
2.
3.
4.
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
TOTAL
£
DECLARATION
I hereby declare that to the best of my knowledge and belief all information given on this claim form is correct.
I also give my authority for my Insurers, their agents and any other authorised body to undertake all necessary enquiries required to
handle my insurance claim.
0.00
If you have any queries please call our Claims Department on 01822 855 555. Please send this form to us by emailing
claims@thmarch.co.uk or, if printing and completing by hand, send this form to: TH March & Co Limited, Hare Park House, Yelverton
Business Park, Yelverton, Devon, PL20 7LS. Telephone: 01822 855 555 Fax: 01822 855 566
TH March & Co Limited is authorised and regulated by the Financial Conduct Authority
TH March Insurance Broker is a trading style of T H March & Co Limited. Registered in England No. 116175
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CLAIM FORM Please complete this form in as (London Institute of Management and Technology)

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Completed 2 July 2021

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