La Soufriere Property Damage Claim Form - St. Vincent Insurances Limited - Vinsure: St. Vincent Insurances Limited

Date of Loss:*

Name of insured*

Name of person submitting the notification if different from the name of insured

Policy Number(s).: (Please list all applicable policy #s)(Please list all applicable policy #s)

Phone*

Other Phone Number

Email*

Physical address of your property*

Please select all that applies to you:*

I incurred damage to my building/home as a result of the volcanic eruption
I incurred damage to my contents as a result of the volcanic eruption
I incurred damage to my vehicle as a result of the volcanic eruption

Please describe what type of loss/damage you have suffered*

Is your asset covered by any other insurance*

Yes
No

What is the name of the other insurer and what is the value of the insurance?*

When was the last time that the property was occupied prior to the loss?*

Was the property being used for Private or Commercial purposes?*

Yes
No

Have actions been taken to mitigate or lessen the damages?*

Yes
No

Please provide details of the actions you have taken

Please upload any pictures you may have of the damage suffered/ incurred

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Accepted file types: jpg, gif, png, pdf.

Please upload any estimate or repair quotation you may have obtained

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VERY IMPORTANT – FRAUDULENT AND EXAGGERATED CLAIMS

The above answers to our questions will be the basis of consideration of your claim. You must ensure that all information is true and correct to the best of your knowledge and belief, and that all material facts have been disclosed. A material fact is one that is likely to influence us in the assessment or acceptance of this claim, or one that is likely to influence our consideration of cover under the terms of your policy. If you are in any doubt as to whether a fact is material, you must disclose it.
FAILURE TO DO THIS MAY MEAN THAT YOUR POLICY BECOMES INVALID AND A CLAIM PAYMENT WILL NOT BE MADE.

DECLARATION*

I/We declare the foregoing particulars to be correct according to my information and belief. I/We understand that you may seek information from other insurers to check the answers I/we have provided. – Make it mandatory for them to click a button to confirm this.

File
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Accepted file types: jpg, gif, png, pdf.

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