Claims | CORE Online Insurance

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.

Policy Holder Details

Policy Number*

Company Name / Insured Name

Title

User's First Name

User's Surname

ID Number*

Cell Number*

Email Address*

Enter Email Confirm Email

Device Details

Make*

Model*

IMEI Number (or serial number if no IMEI)*

Enter *#06# on your keypad for IMEI

Cell Phone Number (if available)

Passcode

If it's a draw code, please type out the numerical sequence (e.g. 1-7-9-3). Otherwise, please type the device password.

Type of Loss / Damage*

Accidental Damage
Theft from Vehicle
Lost Device
Theft

Date of Loss / Damage*

Place of Loss / Damage

Please provide a brief description of what happened in the space below

If the device was lost or stolen

ITC Reference No.*

S.A.P Case No.*

Name of Police Station where reported

If the device was stolen from a vehicle

Fax 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.)

Phone

This field is for validation purposes and should be left unchanged.

CLAIM FORM

Policy Holder Details

Device Details

If the device was lost or stolen

If the device was stolen from a vehicle