To report a new claim please phone 0345 6718171 or complete the form
Tenants' Contents Insurance Scheme Claim Form Office Use Only
Rent Ref. Date last premium paid Number Today's Date Name of Council/Housing Association
ITJITJITJ o=JCLJCLJ
Inception Date Sum Insured
ITJITJITJ !.._______,
Validator Name
Acc. Damage
Standard
Validator Phone Number
Optional extras please specify
Section 1 - Personal Details Name Address
I
---------------------ďż˝-----------------1 Postcode
.ďż˝
Phone: (Home)
Phone: (Business)
Phone: (Mobile)
Section 2 - Details of Incident Address at which loss occurred (if dif ferent from Section 1)
Date of loss/damage
I Postcode
ITJWITJ
Time if known
When and by whom was the loss discovered?
How did the loss, damage or destruction occur? (If theft from building, give details of how entry was gained)
Did the Fire Brigade attend?
Yes
D
No
D
Please complete this section only in the event of Theft or Malicious Damage Were the police notified?
Yes
D
No
D
When and at what police station was the report made? Date
CLJCLJo=J
Station Name and Address
Officer's Name and No: Crime Ref. No: Give details of any witnesses, providing names and addresses
1- ----------------1
Declaration I/We declare that the statements made are true to the best of my/our knowledge and belief and I/we claim the amount above in respect of the items mentioned. I/We understand that you may ask for information from other insurers to check the answers I/we Royal & Sun Alliance Insurance plc, No. 93792 provided. Registered in England and Wales at St. Mark’s Court, Chart Way, Horsham, West Sussex RH12 1XL Claims and Underwriting Exchangeby the Prudential Regulation Authority and regulated by the Financial Conduct Authorised Insurers pass information to the Claims andAuthority Underwriting Exchange Register, run by Insurance Database Services Ltd. (IDS Ltd). The aim and the Prudential Regulation Authority. is to help us check information provided and also to prevent fraudulent claims. When you tell us about an incident (such as fire, water damage or theft) which may or may not give rise to a claim, we will pass information relating to it to the register. Fraud The use of false means or devices in relation to a claim is fraud, even where a claim is otherwise genuine. Where fraudulent means or devices are used the whole claim is forfeit, including any genuine element. The policy may be terminated from the date of the fraud, without refund of premium, and the complaint may be reported to the police.
Please insert claiments name in the box above in order to proceed with your claim Royal & Sun Alliance Insurance plc, No. 93792 Registered in England and Wales at St. Mark’s Court, Chart Way, Horsham, West Sussex RH12 1XL Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.
RSA Claim Form V1 16.03.2016