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Liability Claim Form
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Personal Information
Client Number*
Policy Number* (You can find your policy number on your renewal document, sent to you by your broker.)
Insurance Company*
Policy Holder Details
Name of policy holder*
Occupation*
Contact Person*
Landline Number
Mobile Number*
Email Address*
Address*
Policy Type
Please select from the options provided
Public Liability
Employers Liability
Statutory Liability
Trustees Liability
Professional Indemnity
Directors & Officers
Associations Liability
Consequential Loss
Other
Limit of Indemnity
Excess
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