Vasek Insurance - Claim Form

Tel.0115 950 5052
Mon-Fri 9am to 5pm

Claim Form

For information on how we use your personal data please refer to our UK Privacy Notice

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UK Claim Form

Overseas Claim Form

Make an Online Claim

Policy Number *

Is the policy for an individual or a company? *

Individual Company

Email *

Telephone No. *

Correspondence Address *

Correspondence Address Postcode *

Are you VAT registered? *

Yes No

Property Insured Address *

Property Insured Postcode *

How was the property being used at the time of the loss? *

Was the property unoccupied at the time of loss? *

Yes No

Are you the sole owner of the property for which the claim is made? *

Yes No

Is there any other insurance covering the property concerned? *

Yes No

Date of Occurrence *

Time of Occurrence (If Known)

Full Details of Loss *

How Did the Loss or Damage Occur? *

When Was it Discovered? *

Please give the name of the Police station the incident was reported to If your claim is due to: loss, theft or any malicious act you must notify the Police within 24hours

Crime Reference Number

Have you obtained estimates for the damage to the property? *

Yes No

Original Price	Is this Item Repairable	Estimated cost of Repair or Replacement	Amount Claimed
£	Yes No	£	£
£	Yes No	£	£
£	Yes No	£	£
£	Yes No	£	£
£	Yes No	£	£
£	Yes No	£	£
		Total:	£0

Are there any documents you would like to submit? *

Yes No

Upload your documents

Please Note:

Accepted file types are: PDF, DOC, DOCX, JPEG, JPG, PNG and TXT.

The maximum upload size is 4MB

Any documents of a different format can be supplied to Vasek when you are contacted by a Claims Handler after your claim has been registered.

If you have any further relevant documents, you can send them to Vasek when you are contacted by a Claims Handler after your claim has been registered.

The information supplied to us in this form by either you or anyone acting on your behalf will be used by us when dealing with your claim.

Please be aware that if you or your representative makes a claim under your insurance knowing the claim to be false, fraudulent or intentionally exaggerated in any respect, or makes a statement in support of a claim knowing the statement to be false in any respect or submits a document in support of a claim knowing the document to be forged or false in any respect or makes a claim in respect of any loss or damage caused by your wilful act or connivance then your claim will be void and not paid.

I hereby declare that all details provided by me or my representative in this form are to the best of my knowledge and belief true and are a complete and accurate account of the claim I wish to make.

Please sign the form by entering your name into the box below.

I Agree *

Address

Vasek Insurance Claims Department,
4th Floor,
30-34 Hounds Gate,
Nottingham, NG1 7AB

Telephone

Phone: 0115 950 5052

Email

Email: claims@vasek.co.uk

For information on how we use your personal data please refer to our UK Privacy Notice

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