n The following documents are requested:
Insured Claim Number Broker Reference
tandard Document Disclosure List
Records of inspection for the relevant area
Maintenance records including reports of independent contractors working in relevant area
Records of the minutes of meetings where maintenance or repair policy has been discussed or decided
Records of complaints about the state of the area
Records of other accidents which have occurred on the relevant area
Copies of any contracts or other documents relating to sale or agreement
Copies of leases if accident involves premises
I/We declare that no material information has been withheld and that all statements on this form are true to the best of my/our knowledge and belief.
In addition the articles and property belong to the persons named and no other person has any interest whether as Owner, Mortgagee or Trustee.
I/We understand that you may seek information from other insurers to check the answers I/we have provided, and I/we authorise the giving of such
information for such purposes.
Insurers and their agents share information with each other to prevent fraudulent claims and for underwriting purposes via the Claims and
Underwriting Exchange Register, operated by Insurance Database Services Ltd. A list of participants is available on request. The information
you supply on this form, together with the information you have supplied on your application form and other information relating to the claim,
will be provided to participants.
Signature Date (dd/mm/yyyy)
Please complete and return this form as soon as possible. Damaged property should be protected from further deterioration but not disposed of
without prior reference to the Company. If the claim is for repairable damage i.e. buildings, a Trademan’s estimate will be required.
NIG policies are underwritten by U K Insurance Limited, Registered office: The Wharf, Neville Street, Leeds LS1 4AZ.
Registered in England and Wales No 1179980. U K Insurance Limited is authorised by the Prudential Regulation Authority
and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.
Calls may be recorded.