All risk claim CLAIM FORM – THEFT AND ALL RISKS Please state as fully and as accurately as possible the information asked for below. Acceptance of this form is not an admission of liability by the Insurer.n Step 1 of 4 25% Personal DetailsName*FirstLastOccupation*Address*Street AddressCityZIP / Postal CodeContact Person*Telephone Number General DetailsDate of Loss* Time : HHMMWhen was the loss reported to the police? When and by whom was the loss discovered?Full names of person reporting the loss to the police:Are you the sole owner of the missing or damaged property? Are there any other insurances in force upon the same property? Have you ever had a previous loss by the perils insured? If so please give details and name of Insurer?State name of police station to which the loss was reported? If property was stolen from a building please state:Address of building Was it occupied at time of loss? YesNoIf unoccupied and a residence, for how many days has it been unoccupied during the current period of insurance How was entry effected?What damage was sustained to the building?Which rooms were entered? If the property was stolen from the vehicle please state:State Make, Type and Regn. No. of vehicle Where was it parked at time of theft? What damage did it sustain?PhoneThis field is for validation purposes and should be left unchanged.