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DD slash MM slash YYYY
Where did the loss or damage occur?(Required)
Was another person responsible for the damage?
If damage is the result of fire, did the fire brigade attend?
If damage/loss is the result of burglary, were the police notified?
Please attach a copy of the police report
Items Damaged, Lost or Stolen(Required)
Purchase Date
Replacement Value
Please provided copies of tax invoices or repair quotes.
Please advise if emergency repairs have already been completed
DD slash MM slash YYYY
Drop files here or
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