Liability claims instruction form

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Liability claims instruction form

Please fill out the below form with as much information as possible. Mandatory fields are highlighted with an asterisks.

Is the schedule attached? (for scheme policies)* (optional)

Contact at insured to deal with investigations

Happy for us to contact the insured directly?

Broker contact

Incident information

Please enter the date in the format dd/mm/yyyy

Type of incident*

Please provide applicable type

Time off work

Please enter the date in the format dd/mm/yyyy

Ongoing

Please fill in if applicable but leave blank if still ongoing

Reporting as information only

e.g. Letter of claim, Claim notification form (CNF), Accident book entry (if available)

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