Gadget

Policy Number*

Date insurance purchased*

Loss

Before completing the form, please note that you will need to report your loss via reportmyloss.com and confirmation that this has been completed will be required to continue.

Please provide proof of purchase for the device*

Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 8 MB, Max. files: 4.

Date of loss*

Who was in charge of the equipment when the loss occurred*

Please provide a timeline of how the loss occured*

Where were you located when the loss occurred*

Please provide your loss report*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB, Max. files: 4.

Please provide the name of the insurance company*

Please provide your policy number*

Theft

Before completing the form, please note that you will need to report the theft to the police and you will need to provide a police reference number to continue.

Please provide proof of purchase for the device*

Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 8 MB, Max. files: 4.

Date of theft*

Who was in charge of the equipment when the theft occurred*

Please provide a timeline of how the theft occured*

Where were you located when the theft occurred*

Where was the item kept?*

At any point, where was the device left unattended?*

Who has access to the device?*

Date reported to the police

Police reference*

Which Police station did you use?*

Please provide the name of the insurance company*

Please provide your policy number*

Damage

Please provide proof of purchase for the device*

Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 8 MB, Max. files: 4.

Date of incident*

Who was in charge of the equipment when the damage occurred

How did the incident occur*

Where were you located when the damage occurred*

Please provide photographs of the damage

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB, Max. files: 4.

Please provide the name of the insurance company*

Please provide your policy number*

Loss

Theft

Damage

Additional Information

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