Gadget

1Your Details

2Claim Type

3Declaration

Contact Number*

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.

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 reported to the police

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.

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*

Details of items stolen or damaged

Make*

Model*

Colour*

Serial No*

IMEI*

Where Purchased*

Date Purchased

Purchase Price (inc VAT)*

Last Date of Usage*

Additional Information

If you have any additional information that will assist us with your claim, please include details below

The details you supply will be used to administer your claim and to combat fraud. The answers to the questions will be the basis of the assessment of your claim. All material facts must be disclosed. A material fact is one that is likely to influence us in the assessment or acceptance of this claim, or one that is likely to influence our consideration of cover under the terms of your policy. If you are in any doubt as to whether a fact is material, you must disclose it.I/We submit my/our claim for the amounts stated and declare that, to the best of my/our knowledge and belief, all information given on this form is true and correct, as will be my/our response to any further enquiries made by CompuCover.

Declaration*

I hereby certify that I am the policy holder, I have read the declaration above, and all the information given in this form is truthful, accurate and complete.

CAPTCHA

This field is for validation purposes and should be left unchanged.

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