Eu Law

Topics: Telephone, Mobile phone, Insurance Pages: 6 (1949 words) Published: April 27, 2014
YOUR CLAIM FORM
Claim no: 10954683

The excess you must

Policy no: 29869509

£100.00
13-Jan-2014

Date from printed:

1 - YOUR DETAILS
Full name

Mr Ahok Kumar

Address

Previous name
PostCode
Date of Birth

03-11-1987
Previous

Occupation

address (if
lived at current

Employment

address for

status

PostCode

2 - PHONE DETAILS - What phone are you claiming for?
Please check your phone details below and provide your handset colour & memory size if applicable.

Make & Model

Handset Colour

APPLE IPHONE 5 16GB

Are the details above still correct?
If "no" please provide details of the phone below
Make & Model

IMEI number

Handset Colour

Yes

Mobile number

Airtime provider

013551008582121

white

07807636761

Orange



Memory size
GB

No

IMEI number

Mobile number

Airtime provider

Memory size
GB

Where did you purchase the mobile phone?
Company name/ Store/ Over the phone/ Web

3 - CLAIM DETAILS - What happened?

What has happened to your mobile phone?

Lost

When did you discover what had happened?

Claim Number:

Stolen

Date

10954683

/

Breakdown

Accidentally

/Faulty

lost

(Please tick one)

damaged

/

Time

:

am/pm

*HCLF10954683F*

Correspondence Address: Customer Service Department, Lifestyle Services Group Ltd, PO Box 98, BLYTH, NE24 9DL Lifestyle Services Group Limited | Registered office: Osprey House, Ore Close, Lymedale Business Park, Newcastle Under Lyme, Staffordshire, ST5 9QD | Registered in England No. 5114385 England. Registered No: 1026167. Registered Office: 1 Churchill Place, London E14 5HP. Lifestyle Services Group Limited (Financial Services Register No. 315245) is authorised and regulated by the Financial Conduct Authority in respect of insurance mediation activity only. Barclays Bank PLC (Financial Services Register No. 122702) is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Registered in England. Registered No. 1026167. Registered Office: 1, Churchill Place, London E14 7HP.

PLEASE NOTE: You only need to answer questions in this box for loss and theft claims

Where did the incident occur? (Street and town/ city)

Was the SIM card in the phone at

If no, please

Yes

explain why

the
No
What is the phone number attached to that SIM card?

Who is the main user of the mobile phone?

If someone other than you was responsible for the phone at the time of the incident please provide their details below

Name

Number

Please give full details of what happened. Please include details of all items you're claiming for.

4 - ADDITIONAL DETAILS - Are you claiming for anything else?

Are you also claiming for either of these?

Accessories

(Please tick)
NB - Accessories are only covered if

Unauthorised

they were lost, stolen or damaged in

Network

the same incident.

Charges

Please provide
details of the
accessories
you're
claiming for

5 - CLAIM DETAILS - What did you do?
Please describe in full what you did when you realised your phone was missing/ damaged. For example, if it was lost what steps did you take to retrieve it? If you lost it in a gym or a bar, did you report it to the manager? If you lost it in a taxi, did you call them? Did you try

If you did report the incident to a member
of staff where it happened please let us

Claim Number:

10954683

*HCLF10954683F*

PLEASE NOTE: You only need to answer questions in this box for loss and theft claims

When did you report the incident to the airtime

Date

/

provider?
Did your airtime provider block the phone so it couldn't

Yes

Time

/
No

:

am/pm

:

am/pm

Don't

be used by anyone else. (Please tick)

know

When did you report what had happened to the Police?

Date

/

Time

/

Police station you reported...
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