Make a Claim - Home | Islands Insurance

Insured's Name*
Policy Number*
Postcode Lookup
Address*
Telephone Number*
Email*
Occupation
Have you or any member of your family or any person living with you;
a) made a claim under any insurance policy, or suffered any loss or damage, in the last five years?*
- Yes
- No
b) ever been convicted of any offence involving dishonesty, fraud, voilence, criminal damage, arson?*
- Yes
- No
If ‘Yes’, please provide details:*

Date and time of loss*
Address at which loss or damage occurred:*
When and by whom discovered?*
Were the premises occupied at the time of loss?*
- Yes
- No
When were they last occupied?*

Day
Month
Year
Is the property lent, let or sublet?*
- Yes
- No
State exactly how the loss or damage occurred*
Is there any other insurance in force in respect of this loss?*
- Yes
- No
Insurer*
Policy Number*
Was there any burglary/theft/malicious damage?*
- Yes
- No
Date and time loss reported to police

IMPORTANT: All losses by theft, burglary, housebreaking or malicious damage must be reported to the Police immediately
How was entry gained?
Were there any visable signs of a forced entry into the building?
- Yes
- No
Please provide details*
Crime reference number, if known:
Was an intruder alarm system in operation at the time of the incident?
- Yes
- No
Was the alarm activated?*
- Yes
- No
Theft of bicycles
Was the bicycle securely locked at the time of theft?
- Yes
- No

Details of claim

Got everything you need to support your claim? Please send over any photos (those showing the damage), bills, or price quotes you have. If you're in Guernsey, send an email to [email protected]. If Jersey's your home, send it through to [email protected]

Description of property lost stolen or damaged (Inc. make & model)	Date of purchase	Original purchase price	Estimated cost of repair	Replacement cost if not repairable	Amount claimed	Actions

There are no Items.

Are all of the above items owned by you, or members of your family permanently residing with you?*
- Yes
- No
Who does the property belong to*
Declaration*
- I/We declare that the above statements are true and correct to the best of my/our knowledge and belief.
- I/We have not withheld from the Insurer any information within my/our knowledge connected with this claim.
- I/We warrant that all the information given herein is true and without exaggeration.
- I/We agree to provide the Insurers with any further information or documentation as may be reasonably required.
- I/We declare that the property which belongs to me/us that the property is not insured elsewhere except as stated.
- I agree

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