Deliveroo UK - New Child expenses claim form

To ensure that our claims team can efficiently handle your claim, please ensure all relevant questions relating to your claim are completed. To assist in the handling of your claim:

• Please ensure all supporting documentation is provided.
• Please ensure that all relevant questions are answered and that all appropriate sections, boxes and signatures are completed, failure to do so may delay the processing of your claim.

If you have any questions or queries, please telephone the claims management team by calling 0161 910 1898 or emailing deliverooclaims@ie.sedgwick.com.

What you will need to complete this form:

1. Details of the birth, adoption or stillbirth (inc. name / date of birth where available).
2. Evidence of your birth, stillbirth or adoption - a certified true copy of the birth certificate (apostilled if the birth was outside of the UK) or evidence provided by your adoption agency.
3. Bank details for payment, if you prefer transfer over a cheque.
4. Screenshots of your Deliveroo rider stats for the previous 8 weeks (or previous 6 months if you are the natural birth mother).

Preparing this information will make it easier for you to complete the form, although you can also save this form at any time and return to it later.

Section A - Claim details

Please complete this section to provide your personal details, and information related to your claim.

Section B – Payment Details

In the event that your claim is accepted, you will be paid directly. To be able to process these payments you will need to provide us with your payment details.

Section C – General Data Protection Regulation (GDPR)

Chubb use personal information which you supply to us for underwriting, policy administration, claims management and other insurance purposes, as further described in our Master Privacy Policy, available here or by searching ‘Master Privacy Policy’ on www.chubb.com. You can ask us for a paper copy of the Privacy Policy at any time, by contacting us at dataprotectionoffice.europe@chubb.com.

 Chubb European Group SE (CEG) is a Societas Europaea, a public company registered in accordance with the corporate law of the European Union. Members’ liability is limited. CEG is headquartered in France and governed by the provisions of the French insurance code. Risks falling within the European Economic Area are underwritten by CEG, which is authorised and regulated by the French Prudential Supervision and Resolution Authority (4 Place de Budapest, CS 92459, 75436 Paris Cedex 09, France). Registered company number: 450 327 374 RCS Nanterre. Registered office: La Tour Carpe Diem, 31 Place des Corolles, Esplanade Nord, 92400 Courbevoie, France. Fully paid share capital of €896,176,662.

CEG’s UK branch is registered in England & Wales. UK Establishment address: 100 Leadenhall Street, London EC3A 3BP. Authorised by the Prudential Regulation Authority. Subject to regulation by the Financial Conduct Authority and limited regulation by the Prudential Regulation Authority. Details about the extent of our regulation by the Prudential Regulation Authority are available from us on request. Details about our authorisation can be found on the Financial Conduct Authority website (FS Register number 820988).

Section D – Declaration

Before submitting your claim, please check the details and add your signature on the next section. You will then get the chance to add any more supporting information, before submitting your claim.