财产损失索赔表格
请耐心地填写这个问卷，提供最详细和正确的资料，我们才可以完善地处理您的索赔
Property Loss Claim Form
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
汽车损毁照片 Photos of all damages
受保人的资料 Info about the insured
姓名 Full Name
*
名 First Name
姓 Last Name
您的ID/护照号码 Your ID / passport number
*
您的联络号码 Your contact number
*
-
您的电邮地址 Your email address
*
example@example.com
事故资料 Info about the incident
事件发生的实际地址 Physical address where incident happened
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
事发日期 Date of the incident
-
Month
-
Day
Year
Date
发生时间 Time of incident
房屋的安全受到损害吗？Is the security of the house compromised?
*
是 Yes
不是 No
事发经过的详细内容 Detailed description of the incident
警察案件号码 （如果有的话）Police case number (if applicable)
财产损失，被盗或损坏的声明 Statement of property loss, theft or damage
属性说明 Description of property
数量 Quantity
购买日期 Date bought
购买于 Purchased from
索偿金额 Amount claimed
1
2
3
4
5
6
7
8
9
10
照片 Photos
损毁照片（可以选择多个档案） Photo of damages (multiple selection allowed)
上载多个档案 Upload multiple files
Cancel
of
其他相关资料（例如维修报价） Other relevant info (e.g. repair quote)
上载多个档案 Upload multiple files
Cancel
of
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
提交 Submit
Should be Empty: