Portable Possession Claim 便携财产索取

Portable Possession Claim 便携财产索取

Kindly complete this form and provide detailed and accurate information, so that we can handle your claim effectively
填写表格前，请先准备好以下资料 Please have the following ready before completing the form

事故细节 Info about the incident您的个人资料 Info about the insured如果是盗窃，警方案件编号 Police case number if available
受保人的资料 Info about the insured
车主／投保人／投保公司的英文姓名 Full name of owner / insured*

First NameLast Name
Cell phone number 手机号码*
ID / Passport number 身份证或护照号码*
南非ID是13码；中国护照为9码
您的电邮地址 Your email address*
example@example.com
事故资料 Info about the incident

商品信息 Item Information*

事发日期 Date of the incident*

MonthDayYear
Date
事发时间 Time of the incident*

:HourMinutesAM/PM Option
事发经过的详细内容 Detailed description of the incident*
事发地点 Place of incident*
是否已向警方举报 Was it reported to Police*
有没有其他财产受到损毁？Any damages to other properties?*

有 Yes没有 No
如果是，请提供案件编号 If yes, provide case number
警察局名称 Name of Police Station
其他人的资料 Info about others
目击证人（1）的英文姓名 Full name of witness 1
目击证人（1）的联络号码 Contact number of witness 1
目击证人（2）的英文姓名 Full name of witness 2
目击证人（2）的联络号码 Contact number of witness 2
宣言和签名 Declaration & signature

我在此确认以上资料正确无误，如果还有其他对保障有影响的额外资料，我会尽快提供给我的保险顾问和公司。I hereby declare the foregoing particular to be true in every aspect. If there are additional information that may have a material impact on the policy, I will inform my advisor and insurer as soon as possible
受保人的签名 Signature by the insured *

Clear
Should be Empty:

受保人的资料 Info about the insured