BBi Berns Brett Claims Reporting Services

Property Claims Reporting Services
If you need to make a claim fill in the form below,
email us here or contact us by telephone on 0800 3588 222.

SECTION 1 - Insured

Title
Full Name
Number & Street
Area/Town
City/County
Postcode
Telephone Number
Mobile Phone
Fax Number
Email Address
Berns Brett Client No.
Policy No.
Your Insurance Company

SECTION 2 - Accident

Business / Occupation
Date
Time
Address / location of loss
When was the accident first notified
By whom was the accident first notified
Names and addresses of witnesses
State fully the circumstances that led to loss or damage
Type of Property (e.g. Shop, House, Hotel, Warehouse etc.
Have you held the individuals responsible for this loss liable, e.g. Carriers
Are you the owner of the premises
If not, are you responsible for repairs, and if so, state why
Give details if you previously sustained loss or damage of this nature at these premises or elsewhere
Is the property for which you are claiming insured under any other policy ? If so give details of Insurer and Policy number

SECTION 2 - Claims

Were the premises unoccupied
If premises unoccupied, state date and time they were last occupied
If Theft, give details if there was forcible and violent entry to or exit from the premises
When and which police station was notified
Are the premises protected by alarms
If so, did it operate
Is a maintenance contract in force for the alarm

SECTION 3 - Details of loss or damage

Description of property or item 1
Who owns the item
Est. cost of repairs
Age of item (years)
Cost to insured
Amount claimed
Description of property or item 2
Who owns the item
Est. cost of repairs
Age of item (years)
Cost to insured
Amount claimed
Description of property or item 3
Who owns the item
Est. cost of repairs
Age of item (years)
Cost to insured
Amount claimed
Description of property or item 4
Who owns the item
Est. cost of repairs
Age of item (years)
Cost to insured
Amount claimed
If further losses please provide the details (as required above) :

SECTION 3 - Breakage of Glass

What glass was damaged, state whether door, window etc.
Type of glass
No of squares
Damage to the glass
Have you given instructions for replacement
Have the premises been made secure
Please tick the box to agree that the information supplied in this form is accurate to the best of your knowledge/belief.
All information supplied is used by Berns Brett Ltd for underwriting purposes.