General Claim

Insured

Insured First Name *
Insured Last Name *
Insured Contact *
Insured Contact E-Mail *
Insured Address (line 1)
Insured Address (line 2)
Insured Address (line 3)
Insured Tel (Work)
Insured Tel (Home)
Insured Tel (Cell)
Insured Policy No
Insured Vat No
Exact Type of Aircraft
Aircraft Reg No
Please leave this field empty.

Loss

State Where Loss Occured
Cause of Loss
Date of Loss
Time of Loss
Exactly How Did The Loss Occur
Was This Due To Another Parties Negligence ---YesNo
If Yes: Supply This Parties Contact Details (Name, Address, Contact Phone)
Have You reason To Suspect Anyone ---YesNo
If Yes: Supply This Parties Contact Details (Name, Address, Contact Phone)
At Which Police Station Did You Report This Loss
If Not Reported, Please State Reason
What Is a Reasonable Valuation of the Loss
Is There Any Other Insurance Covering the Items ---YesNo
Have You Claimed Previously ---YesNo
If Yes, Give Details