This form should be completed as fully as possible and emailed immediately to your broker. Please do not leave any blank spaces, although ‘N/A’ may be inserted where appropriate.

Report of Public Liability claim

    1. Policyholder details

  • 2. Accident details

  • Please give a full description of the accident

  • 3. Details of the damaged property

  • 4. Details of persons injured

  • The above particulars are true to the best of my belief, in every respect.