Islamic Insurance

Insurance Details

Type of Insurance

Policy No

Name of Insured

Address

Tel/Mobile

Accident / Incident Details

When and where did the accident happen? Time,data, and place (Please state as fully as possible)

Description of Accident

Nature & extend of Damage

Whether the Police were informed of the accident? Yes/ No (If so, please enclose Police Report.)

Yes No

Upload Police Report file Allowed file types(*.pdf)

Injury and Property Damage

If any persons not in your service were injured, please state

Was any Third party property damaged?(If yes, please give particulars)

Have you received any notice of a claim?(If yes, please give particulars)

Any further information?

File Upload

Upload Incident Report with Photos (if any) Allowed file types(*.pdf)

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Insurance Details

Insurance Details

Accident / Incident Details

Injury and Property Damage

File Upload

Abcd?

I/We hereby confirm truth of the foregoing information to the best of my/our knowledge/belief.

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