Claim Information:

  • CET Reference:

  • Insured Name:

  • Client:

  • Date Of Complaint:

  • Repair Team:

  • Repair Leader:

  • Date Of Visit:

  • Time:

  • Present During Visit:

  • Address:
  • Contact Tel No:

  • Description of Complaint / Concern:

Repair Team Comments:

  • Add media

Repair Leaders Findings:

  • Add media

Resolution:

  • Resolution Date Agreed?

  • Resolution Date:

  • All Parties Aware of the Dates?

  • Concerns / Complaints Justified:

  • Is Compensation Due?

  • If Yes, Who are we receiving monies from?

Additional Information:

Signatures:

  • CET Representative:

  • Insured / Representative:

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