Call 0844 478 0088

Contact us

Instruction Form

inform...advise...support

We will confirm to you, via email, that we have taken receipt and are acting on your instructions, within one hour.

Date

Reference

Insured

Incident

Incident date

From

Direct line

Liability established
Yes No

Delegated authority
Yes No

Action / Advice required / Brief

Products involved

Additional comments / Notes

Contact at insured

Contact Tel No

Insured’s Address

Is the insured V.A.T. registered?
Yes No Not Known

Policy excess

Claim ref

Policy number

Single article limit

BI Cover
Yes No

Broker

Broker contact

Broker contact number

Please note your details will be kept confidential and will never be passed on to any third parties.