272 Gunnersbury Avenue
London, W4 5QB
Fax: 020 3249 7942
Please make sure you complete all of the fields, otherwise your claim may be delayed or declined.
If we find any false or misleading details we can refuse to settle the claim and may cancel your policy. If we have any reason to suspect that fraud is being committed, it will be investigated and may lead to your prosecution. We may put details of your lost or stolen phone onto a central equipment register and report it to relevant authorities for the purpose of crime detection and prevention.
* Please complete all of the fields in CAPITALS using BLUE or BLACK ink only.
* Once you start your claim, you have 60 days to complete it.
* If you provide us with your email address, we’ll contact you as soon as we can with our claim decision
Section 1: About You
Daytime Contact Number Evening Telephone Number
Section 2: About Your Phone
Mobile Number (of the phone you are claiming for) Make (Manufacturer eg. Blackberry, Apple, LG etc)
Model (eg: Xperia, iPhone4 32GB, Tocco) Colour
IMEI (shown on your insurance certificate. If you have the phone, remove the back as the IMEI is printed under the battery)
Section 3: About the Incident
Claim Reason (tick): Lost Stolen Damaged Faulty
Last message sent: SMS email Call None
Date you last used the phone (dd/mm/yyyy) Incident Date / Date Incident Discovered (dd/mm/yyyy)
/ / / /
Where is the phone / where did you last see it?