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Bankers Indemnity/Fidelity Gurantee Claim Form
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Bankers Indemnity/Fidelity Gurantee Claim Form
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This Form is to be completed and signed by the insured and sent to the insurer immediately the damage/loss/fraud is discovered. The company does not admit liability by the issue of this form.
Policy No
Insured
Address
Telephone no
E-mail Address
When did the loss occur?
Name of Branch manager/ Head of Dept
Name of Schedule Officer(s)
Name of Culprit(s) if known
How was loss/damage/fraud detected?
Brief account of the loss/damage/fraud
Brief account of the loss/damage/fraud (copy)
Date on which loss/damage /fraud was detected:
If continuous act, give duration of act. From - To
State Amount of Estimated claim
Breakdown of claim amount/ loss
State measures taken to minimize future loss/damage/fraud:
Has incident been reported to the police?
Yes
No
If yes, which police Station
Have you insured with any other company?
Yes
No
If yes, please give name of company
NB: Any other relevant information could be attached below.
File Upload
Click or drag a file to this area to upload.
I/We hereby declare that the above statements are true to the best of my/our knowledge and belief.
Submit
Home
About Us
Company History
Board of Directors
Management Team
Other Key Staff
Our Products
Branch Offices
Claims
Motor Vehicles Accident Report Form
Workmen’s Compensation Claim Form
Goods-In-Transit Claim Form
Bankers Indemnity/Fidelity Gurantee Claim Form
Gallery
News
Contact Us
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