CLAIM FORM Step 1 of 3 33% NOTE: Our claims process starts with the completion of this form. All lost/stolen Mobile Devices must be reported to the SAPS within a maximum of 48 hours from discovery of the loss. This form must be completed and submitted within 30 days from the date of loss.ID Number* Cell Number* Policy devicesSelect the device this claim pertains to* Device DetailsType of Loss / Damage* Accidental Damage Theft from Vehicle Lost Device Theft Date of Loss / Damage* DD dash MM dash YYYY Place of Loss / Damage Please provide a brief description of what happened in the space belowPlease upload any documents required for your claim submissionCopy of IDAccepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.Allowed file types: jpg, jpeg, gif, png, pdfAffidavitAccepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.Allowed file types: jpg, jpeg, gif, png, pdfOther docs (Photo of phone box) and (iStore Statement)Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.Allowed file types: jpg, jpeg, gif, png, pdfIf the device was lost or stolenITC Reference No.* S.A.P Case No.* Name of Police Station where reported If the device was stolen from a vehicleFax or email a copy of the invoice for repairs to your vehicle to 086 505 6721 / claims@adminplus.co.za.How was entry gained?Claims Declaration* I hereby agree that:I understand that I am fully bound by my conscience in making this statement and that any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. I hereby agree that the Insurers of the Policy may take over and conduct this prosecution for their own benefit of any claim for cover or otherwise and shall have full discretion in the conduct thereof. (Please complete a separate form for each item being claimed.) I/We hereby declare that all the information declared above is true in every respect and that I/We have not withheld any relevant information and I/We will assist with any additional information that is required to finalise this claim. I/We hereby authorise Adminplus/the Insurer to carry out any checks required to validate my/our claim including but not limited to ITC checks, Beacon and Billings information, last Usage, CCTV footage and SAPS information. I understand that I am fully bound by my conscience in making this statement and any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above. I hereby agree that the insurers of the policy may takeover and conduct any prosecution for their own benefit of any claim cover or otherwise and shall have full discretion in the conduct thereof.Collection & DeliveryCollection address/StoreSelect storeiStore BallitoiStore BrooklyniStore Canal WalkiStore Cape Gate iStore Cape Gate Pre-OwnediStore CavendishiStore CenturioniStore ClearwateriStore Constantia Pre-OwnediStore CrestaiStore East RandiStore EastgateiStore FourwaysiStore Garden RouteiStore GatewayiStore HighveldiStore IlangaiStore Kolonnade iStore Loch LoganiStore Mall of AfricaiStore Mall of the NorthiStore MaponyaiStore MenlyniStore MidlandsiStore PavilioniStore Queens HoteliStore Sandton CityiStore Sandton DriveiStore SomersetiStore StellenboschiStore Table BayiStore The GleniStore TygervalleyiStore Vaal MalliStore Walmer ParkiStore WaterfrontiStore WoodlandsiStore iStore Pre-Owned RosebankiStore iStore RosebankOtherDelivery address/StoreSelect storeiStore BallitoiStore BrooklyniStore Canal WalkiStore Cape Gate iStore Cape Gate Pre-OwnediStore CavendishiStore CenturioniStore ClearwateriStore Constantia Pre-OwnediStore CrestaiStore East RandiStore EastgateiStore FourwaysiStore Garden RouteiStore GatewayiStore HighveldiStore IlangaiStore Kolonnade iStore Loch LoganiStore Mall of AfricaiStore Mall of the NorthiStore MaponyaiStore MenlyniStore MidlandsiStore PavilioniStore Queens HoteliStore Sandton CityiStore Sandton DriveiStore SomersetiStore StellenboschiStore Table BayiStore The GleniStore TygervalleyiStore Vaal MalliStore Walmer ParkiStore WaterfrontiStore WoodlandsiStore iStore Pre-Owned RosebankiStore iStore RosebankOtherEmailThis field is for validation purposes and should be left unchanged.
