Toshiba Computer Cover

Claim Form
To ensure your claim is dealt with as quickly as possible, please complete this form in full.

Your claim will be delayed if you do not complete all relevant sections. All claims must be referred to the Claims Administrators before you take any action. Failure to do so will invalidate your claim.

For a claim that is not capable of repair e.g. following theft, the Claims Administrators will instruct our authorised supplier to arrange replacement to comply with general condition 2 (basis of settlement) of the Certificate.

Fields marked with an * are mandatory.

The claim form will need to be completed in full by the named Policyholder. If the Policyholder requires someone else to complete the form on their behalf, then due to the Data Protection Act we will need the name and address of the person who will complete the form on the Policyholder's behalf. This information will need to be provided by the Policyholder and in writing either by post, fax or email).

Policy Number *

Purchase date of equipment *

Where did you purchase your equipment from? *

Purchase date of insurance *

WARNING: If in the course of claim validation, misrepresentation of the facts is discovered we will consider this as fraud. Details of all such cases will be passed to the appropriate agencies for action.

Section 1: Name of Insured

Title

Name *

Company/School

Address

Postcode *

Tel. Daytime *

Tel. Home

Tel. Mobile

Email *

If you are claiming for damaged property click here

If you are claiming for stolen property click here

Section 2: Damage
(please ensure all data on the hard drive is backed-up prior to collection)

Who was in charge of the equipment when damage occurred:

Explain the full circumstances of how the damage occurred:

Date and time when the damage occurred:

Explain the full circumstances of where you and the equipment were located at the time of the incident:

Date, time and by whom the damage was discovered:

Explain the full circumstances of what damage has occurred:

Section 3: Theft

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

Date and time the theft occurred:

Explain the full cicumstances of where you and the equipment were located at the time of the theft:

Date and time when it was discovered:

Do your suspicions rest on anyone? If so on whom?

Explain the full circumstances of the date, time and location when the equipment was last seen:

In all cases the Police must be advised within 24 hours. Please state the following:

*Date Reported

*Name of Police Station

*Tel. No of Police Station

*Police Crime Number

*N.B. Failure to provide will invalidate claim.

Section 4 *: Full description of property damaged or stolen (including Serial Number(s))

Section 5: Is there any other insurance covering the property concerned?

Yes

If yes, please supply details below

Section 6: Are you a taxable company for VAT purposes?

Yes

If yes, can you recover the value added tax which will be included in the cost of repairing or replacing the property for which you are claiming? If not, please state % and reason

DECLARATION: The information I have provided is true and accurate to the best of my knowledge. I understand that CompuCover may ask for further information in support of my claim. I agree to provide any further information if requested. I understand CompuCover may share information with other insurance providers in order to prevent fraudulent claims

Please tick this box to confirm you have read the declaration *

Please tick this box to confirm you will be providing your proof of purchase for the equipment you are claiming for *

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