AJ Consultancy Ltd Insurance Claim Form V0118

• Client / Site

• Date and initials of person completing the form in format (ddmmyyfl)

• Date and Time of Incidence.

  Date

General property details

• ASPRAY CLAIMS MANAGEMENT ACKNOWLEDGE THE FOLLOWING IMPORTANT INFORMATION
  
  AVIVA Policy Number 123456789
  Policyholder Name Anthony James Consultancy Ltd
  Policyholder Reg Address : Charlotte House, 35-37 Hoghton Street, Southport, PR9 0NS.
  Tel : 01704 545800
  Email : pm@ajestateagents.co.uk
  
  Anthony James Consultancy Ltd is a Property Management company who is ARMA-Q regulated and whom acts for and on behalf a number of Clients.
  Payments can be made directly to the appointed contractors.
  
  IMPORTANT PLEASE READ - FRANCHISE AGREEMENT NO EXCESS ON POLICY
  Anthony James Consultancy Ltd's AVIVA Policy has a Franchisee agreement kinked to the policy.
  This means that there is no claim(payout) if the total claim is less than £500 inc VAT.
  If the total claim is over £500 inc VAT then AVIVA will payout on the entire claim without any excess or deduction at all.
  ASPRAY CLAIMS HANDLERS MUST BE AWARE OF THIS AND CONFIRM THIS BY EMAIL to pm@ajestateagents.co.uk
  PRIOR TO INSTRUCTING CONTRACTORS.
  
  

• Property Address including flat number

• General construction of property.

• Number of storeys in block

• Storey of property damage

• Type of occupier

  Select Owner Occupier Tenant Occupier

  • Owner Occupier
  • Tenant Occupier

Details of damage.

• Date & Time of incident

  Date

• General description of incident. Witnesses and who discovered the damage.

• Type of damage

  Select Fire Flood Escape of Water/leak Theft Criminal Damage Terrorism Storm/Wind Injury Claim

  • Fire
  • Flood
  • Escape of Water/leak
  • Theft
  • Criminal Damage
  • Terrorism
  • Storm/Wind
  • Injury Claim

• Crime reference number if applicable

• Location of damage

• Photos of damage.

  Media

• General floorplan sketch.

  Drawing

• Estimated cost of damage.

  Select 0-£1000 est damage £1000-£3000 est damage £3000+ est damage

  • 0-£1000 est damage
  • £1000-£3000 est damage
  • £3000+ est damage