insurance4mycaravan Trailer Tent/Folding Caravan Claim Form · Trailer Tent/Folding Caravan Claim...
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insurance4mycaravan Trailer Tent/Folding Caravan Claim Form Policy No: Date ordered: 1 Your Details Name of insured Address Daytime Tel. No. Mobile No. Postcode 2 Trailer Tent/Folding Caravan Equipment Details insurance4mycaravan Thorpe Underwood Hall Ouseburn, York YO26 9SS Tel: 08449 809 789 Fax: 08449 809 410 email: [email protected] Web: www.insurance4mycaravan.co.uk The issue of this claim form does not constitute an admission of claim liability. This form must be returned to us within 90 days of the loss occurring. Please ensure that you supply all necessary receipts, invoices and documentation to substantiate your claim. Missing information may result in the delay of your claim. Please complete all relevant sections in full. Missing information may result in the delay of your claim. If you require further space please attach a separate sheet of paper with your claim form. SETTLEMENT In the event of claims settlement becoming due We will issue settlement by BACS transfer. Where bank account details have not been provided or this is not possible, settlement will be despatched by cheque. Settlement will be issued to You unless otherwise requested. You can select an alternative payee by ticking the relevant box on the claim form You fill in and by providing the third party name. CLAIM FORMS WHICH ARE INCOMPLETE WILL BE RETURNED TO THE POLICYHOLDER FOR COMPLETION. IMPORTANT NOTES Contacting Us If you have any queries, please call 08449 809 789 Evening Tel. No. email 3 What are you claiming for? Please tick all the relevant boxes Theft Accidental Damage, Fire, Flood or Storm Alternative Accommodation Make Model CRiS registration no. Caravan’s storage address Postcode Manfacture Date Is this a CaSSOA storage site? Yes No Date of purchase Price paid Is there currently finance oustanding on this caravan Yes No If yes, please provide details of the finance company below. Finance company’s contact details Phone No. Postcode Please list any equipment and/or personal effects you wish to claim for (please use a separate sheet of paper if necessary) Description Price paid Date bought Agreement number 4 Incident Details Exact date and time of incident Please provide us with the details of where the incident occurred Postcode Name of the last person(s) towing the caravan/trailer tent What is the relationship of the above to the policyholder? What category of licence does the above hold? How long in years & months has the above been caravanning? Year(s) & Months WC1 insurance4mycaravan.co.uk is a scheme administered and underwritten by the Equine & Livestock Insurance Co Ltd (E&L®) which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority no. 202748. This can be checked by visiting the FCA’s website or by contacting the FCA on 0800 111 6768.
Transcript of insurance4mycaravan Trailer Tent/Folding Caravan Claim Form · Trailer Tent/Folding Caravan Claim...
insurance4mycaravanTrailer Tent/Folding CaravanClaim Form
Policy No:
Date ordered:
1 Your Details
Name of insured
Address
Daytime Tel. No.
Mobile No.
Postcode
2 Trailer Tent/Folding Caravan Equipment Details
insurance4mycaravanThorpe Underwood Hall
Ouseburn, YorkYO26 9SS
Tel: 08449 809 789Fax: 08449 809 410
email:[email protected]
Web:www.insurance4mycaravan.co.uk
The issue of this claim formdoes not constitute anadmission of claim liability.
This form must be returnedto us within 90 days of theloss occurring.
Please ensure that yousupply all necessaryreceipts, invoices anddocumentation tosubstantiate your claim.Missing information mayresult in the delay of yourclaim.
Please complete all relevantsections in full. Missinginformation may result in thedelay of your claim.
If you require further spaceplease attach a separatesheet of paper with yourclaim form.
SETTLEMENT
In the event of claimssettlement becoming due Wewill issue settlement byBACS transfer. Where bankaccount details have notbeen provided or this is notpossible, settlement will bedespatched by cheque.Settlement will be issued toYou unless otherwiserequested. You can selectan alternative payee byticking the relevant box onthe claim form You fill in andby providing the third partyname.
CLAIM FORMS WHICH ARE INCOMPLETE WILL BE RETURNED TO THE POLICYHOLDER FOR COMPLETION.
IMPORTANT NOTES
Contacting UsIf you have any queries, please call
08449 809 789Evening Tel. No.
3 What are you claiming for?
Please tick all the relevant boxes
Theft Accidental Damage, Fire, Flood or Storm Alternative Accommodation
Make Model
CRiS registration no.
Caravan’sstorage address
Postcode
Manfacture Date
Is this a CaSSOA storage site? Yes No
Date of purchase Price paid
Is there currently finance oustanding on this caravan Yes No
If yes, please provide details of the finance company below.
Finance company’scontact details
Phone No.Postcode
Please list any equipment and/or personal effects you wish to claim for (please use a separate sheet of paper ifnecessary)
Description Price paid Date bought
Agreement number
4 Incident Details
Exact date and time of incident
Please provide us withthe details of where theincident occurred
Postcode
Name of the last person(s) towing the caravan/trailer tent
What is the relationship of the above to the policyholder?
What category of licence does the above hold?
How long in years & months has the above been caravanning? Year(s) & MonthsWC1
insurance4mycaravan.co.uk is a schemeadministered and underwritten by theEquine & Livestock Insurance Co Ltd
(E&L®) which is authorised by thePrudential Regulation Authority andregulated by the Financial Conduct
Authority and the Prudential RegulationAuthority no. 202748. This can be checked
by visiting the FCA’s website or bycontacting the FCA on 0800 111 6768.
4 Incident Details continuedPlease provide us with a full description of events. If necessary please use a diagram to assist. Please use a separate sheet of paper if you requirefurther space.
Have you reported the incident to the police? Yes
Date reported to the police Please enclose confirmationfrom the police of the reportincluding the crimereference number
No
Police station reported to
Reporting officer
Crime reference No
What security precautions were in place at the time of the incident for both the caravan/trailer tent and storage location where applicable (e.g. wheelclamp, hitchlock alarm, security fence etc). Please provide evidence of the security in place. Do not dispose of keys to stolen security devices or anydamaged security devices as they may be required for inspection.
What precautions have you taken to avoid a similar loss occurring?
Please provide us with details oftwo establishments from which youhave obtained repair estimates
Postcode
Postcode
Please ensure that the estimatesof repair are sent with your claim
For claims under this section you are required to provide us with a proof of purchase.
7 Alternative Accommodation
Please provide us with the detailsof the alternative accommodation
Postcode
Please provide us with confirmation of your initial holiday booking along with invoices for the alternative accommodation.
Dates of stay in the alternativeaccommodation
From To
8 DeclarationHave you or any persons to whom this insurance applies ever:
a) been declared bankrupt?
b) been convicted of arson, fraud, forgery, theft, robbery, receiving stolen goods or any other crime of violence associated with any of these offences or with any other
offence against property?
c) suffered from a physical defect, infirmity or serious medical condition?
I hereby declare that the details given by me, are to the best of my knowledge, true and complete.
Yes No
Yes No
Yes No
DatePolicyholder’s Signature
Please note that we do not cover any costs in relation to storage costs, you are responsible for any costs. In the event of a total loss claim thesefacts must be settled before the caravan/trailer tent can be collected and settlement is issued.
5 Claims for theft, arson, vandalism and break-ins only
6 Claims for accidental damage, accidental fire, flood and storm only
WC1
Me Thirdparty
In the event of settlement becoming due, toWhom should payment be made?
Name
Yes NoCould this claim potentially be covered underany other policy of insurance? If Yes, pleaseprovide full details.
