011 879 7200 / 7250

St Andrews Office Park

39 Wordsworth Avenue, St Andrews.

Stay informed! Visit the SA Department of Health’s website for COVID-19 updates: sacoronavirus.co.za

011 879 7200 / 7250

St Andrews Office Park

39 Wordsworth Avenue, St Andrews.

Personal Liability Claims Form

SECTION 1: INSURED

SECTION 2: INCIDENT

SECTION 3: WITNESS

SECTION 4: POLICE

SECTION 5: TYPE OF LOSS/DAMAGE

SECTION 6: PERSONAL INJURIES (IF APPLICABLE)

SECTION 7: CLAIM

Upload claim correspondence..

SECTION 8: DESCRIPTION OF INCIDENT

SECTION 9: DECLARATION

I/ We hereby declare that to the best of my/our knowledge the above statements are true.

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