New Claim Instruction Form - Equitas Insurance Loss Adjustors and Surveyors Malta

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NEW INSTRUCTIONS – CLAIMS

Please complete this form to give us details of new claims instructions.

Instructions will be acknowledged within 24 hours of receipt

Equitas, Loss Adjusters Surveyors & Consultants


Basic Information
Date of Instructions		Time:
Our Ref:
Instructing Office:	Name
	Contact Person
	Contact Email

Insured:	Name
	Contact Person
	Tel/Cell No.

Broker: (If applicable)	Name
	Contact Person

Claim:	Type Of Loss
	Date Of Loss
	Date Notified

Policy:	Type/s
Remarks:


Optional Information – May be provided later
Insured:	Address
	Contact Person
	Tel/Cell No.

Instructing Office:	Claim No.

Policy	Cover
	Policy No
	Sums Insured
	Deductible

INSTRUCTIONS WILL BE ACKNOWLEDGED WITHIN 24 HOURS OF RECEIPT

This form may be printed and sent by fax on 21 445 449

Please fax/e-mail a copy of the relevant policy schedule/s and endorsements as well as a blank claim form at your earliest convenience.

(00356) 21 445 449
or
(00356) 998 998 81

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