CLAIM FORM 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 DetailsPolicy Number*Company Name / Insured NameTitleUser's First NameUser's SurnameID Number*Cell Number*Email Address* Enter Email Confirm Email Device DetailsMake*iMaciMac ProMac MiniMacBook AirMacBook Pro RetinaiPad Mini 5iPad 6iPad 7iPad 8iPad AiriPad ProiPhone 6SiPhone 7iPhone 8iPhone SEiPhone XRiPhone 11iPhone 11 ProiPhone 11 Pro MaxiPhone 12 miniiPhone 12iPhone 12 ProiPhone 12 Pro MaxModel*21.5-inch 2.3GHz Dual-Core Intel Core I5, 8GB 1TB21.5-inch with Retina 4K display: 3.0GHz 6-core, 8GB, 8th-generation Intel Core i5 processor, 1TB27-inch with Retina 5K display: 3.7GHz 6-core, 8GB, 9th-generation Intel Core i5 processor, 2TB21.5-inch 2.3GHz dual-core 7th-generation Intel Core i5 processor, 256GB21.5-inch with Retina 4K display: 3.6GHz quad-core 8th-generation Intel Core i3 processor, 256GB21.5-inch with Retina 4K display: 3.0GHz 6-core 8th-generation Intel Core i5 processor, 256GB27-inch with Retina 5K display: 3.1GHz 6-core 10th-generation Intel Core i5 processor, 256GB27-inch with Retina 5K display: 3.3GHz 6-core 10th-generation Intel Core i5 processor, 512GB27-inch with Retina 5K display: 3.8GHz 8-core 10th-generation Intel Core i7 processor, 512GB27-inch with Retina 5K display: 3.2GHz 8-core Intel Xeon W27-inch with Retina 5K display: 3.0GHz 10-core Intel Xeon W processor3.6GHz Quad-core 8th-generation Intel Core i3 processor, 256GB3.0GHz 6-core 8th-generation Intel Core i5 processor, 512GBApple M1 chip with 8-core CPU and 8-core GPU, 256GB SSDApple M1 chip with 8-core CPU and 8-core GPU, 512GB SSD13-inch 1.8GHz Dual-Core Intel Core I5, 128GB13-inch 1.6GHz dual-core 8th-gen Intel Core i5 processor, 128GB - Space Grey13-inch 1.1GHz dual-core 10th-generation Intel Core i3 processor, 256GB - Space Grey13-inch 1.1GHz dual-core 10th-generation Intel Core i3 processor, 256GB - Silver13-inch 1.1GHz dual-core 10th-generation Intel Core i3 processor, 256GB - Gold13-inch 1.1GHz quad-core 10th-generation Intel Core i5 processor, 512GB - Space Grey13-inch 1.1GHz quad-core 10th-generation Intel Core i5 processor, 512GB - Silver13-inch 1.1GHz quad-core 10th-generation Intel Core i5 processor, 512GB - Gold13-inch Apple M1 chip with 8-core CPU and 7-core GPU, 256GB - Space Grey13-inch Apple M1 chip with 8-core CPU and 7-core GPU, 256GB - Silver13-inch Apple M1 chip with 8-core CPU and 7-core GPU, 256GB - Gold13-inch Apple M1 chip with 8-core CPU and 8-core GPU, 512GB - Space Grey13-inch Apple M1 chip with 8-core CPU and 8-core GPU, 512GB - Silver13-inch Apple M1 chip with 8-core CPU and 8-core GPU, 512GB - Gold13-inch Touch Bar 1.4GHz quad-core 8th-gen Intel Core i5 processor, 128GB - Space Grey13-inch Touch Bar 1.4GHz quad-core 8th-gen Intel Core i5 processor, 256GB - Space Grey13-inch Touch Bar 1.4GHz quad-core 8th-gen Intel Core i5 processor, 512GB - Space Grey13-inch Apple M1 chip with 8-core CPU and 8-core GPU, 256GB SSD - Space Grey13-inch Apple M1 chip with 8-core CPU and 8-core GPU, 256GB SSD - Silver13-inch Apple M1 chip with 8-core CPU and 8-core GPU, 512GB SSD - Space Grey13-inch Apple M1 chip with 8-core CPU and 8-core GPU, 512GB SSD - Silver13-inch Touch Bar 2.4GHz quad-core 8th-gen Intel Core i5 processor, 512GB - Silver13-inch Touch Bar 2.4GHz quad-core 8th-gen Intel Core i5 processor, 512GB - Space Grey13-inch Touch Bar 2.0GHz quad-core 10th-gen Intel Core i5 processor, 512GB - Space Grey13-inch Touch Bar 2.0GHz quad-core 10th-gen Intel Core i5 processor, 512GB - Silver13-inch Touch Bar 2.0GHz quad-core 10th-gen Intel Core i5 processor, 1TB - Space Grey13-inch Touch Bar 2.0GHz quad-core 10th-gen Intel Core i5 processor, 1TB - Silver16-inch Touch Bar 2.6GHz 6-core 9th-generation Intel Core i7 processor, 512GB - Space Grey16-inch Touch Bar 2.6GHz 6-core 9th-generation Intel Core i7 processor, 512GB - Silver16-inch Touch Bar 2.3GHz 8-core 9th-generation Intel Core i9 processor, 1TB - Space Grey16-inch Touch Bar 2.3GHz 8-core 9th-generation Intel Core i9 processor, 1TB - SilverWi-Fi 64GB - Space GreyWi-Fi 64GB - SilverWi-Fi 256GB - Space GreyWi-Fi 256GB - SilverWi-Fi 256GB - GoldWi-Fi + Cellular 64GB - Space GreyWi-Fi + Cellular 64GB - SilverWi-Fi + Cellular 256GB - Space GreyWi-Fi + Cellular 256GB - SilverWi-Fi + Cellular 256GB - GoldiPad Wi-Fi + Cellular 32GB - Space GreyiPad 10.2-inch 7th Gen Wi-Fi 32GB - Space GreyiPad 10.2-inch 7th Gen Wi-Fi 32GB - SilveriPad 10.2-inch 7th Gen Wi-Fi 32GB - GoldiPad 10.2-inch 7th Gen Wi-Fi 128GB - Space GreyiPad 10.2-inch 7th Gen Wi-Fi 128GB - SilveriPad 10.2-inch 7th Gen Wi-Fi 128GB - GoldiPad 10.2-inch 7th Gen Wi-Fi + Cellular 32GB - Space GreyiPad 10.2-inch 7th Gen Wi-Fi + Cellular 32GB - SilveriPad 10.2-inch 7th Gen Wi-Fi + Cellular 32GB - GoldiPad 10.2-inch 7th Gen Wi-Fi + Cellular 128GB - Space GreyiPad 10.2-inch 7th Gen Wi-Fi + Cellular 128GB - SilveriPad 10.2-inch 8th Gen Wi-Fi 32GB - Space GreyiPad 10.2-inch 8th Gen Wi-Fi 32GB - SilveriPad 10.2-inch 8th Gen Wi-Fi 32GB - GoldiPad 10.2-inch 8th Gen Wi-Fi 128GB - Space GreyiPad 10.2-inch 8th Gen Wi-Fi 128GB - SilveriPad 10.2-inch 8th Gen Wi-Fi 128GB - GoldiPad 10.2-inch 8th Gen Wi-Fi + Cellular 32GB - Space GreyiPad 10.2-inch 8th Gen Wi-Fi + Cellular 32GB - SilveriPad 10.2-inch 8th Gen Wi-Fi + Cellular 32GB - GoldiPad 10.2-inch 8th Gen Wi-Fi + Cellular 128GB - Space GreyiPad 10.2-inch 8th Gen Wi-Fi + Cellular 128GB - SilveriPad 10.2-inch 8th Gen Wi-Fi + Cellular 128GB - GoldiPad Air 10.5-inch Wi-Fi 64GB - Space GreyiPad Air 10.5-inch Wi-Fi 64GB - SilveriPad Air 10.5-inch Wi-Fi 64GB - GoldiPad Air 10.5-inch Wi-Fi 256GB - Space GreyiPad Air 10.5-inch Wi-Fi + Cellular 64GB - Space GreyiPad Air 10.5-inch Wi-Fi + Cellular 256GB - Space GreyiPad Air 10.5-inch Wi-Fi + Cellular 256GB - Silver10.9-inch Wi-Fi 64GB - Space Grey10.9-inch Wi-Fi 64GB - Silver10.9-inch Wi-Fi 64GB - Rose Gold10.9-inch Wi-Fi 64GB - Sky Blue10.9-inch Wi-Fi 64GB - Green10.9-inch Wi-Fi 256GB - Space Grey10.9-inch Wi-Fi 256GB - Silver10.9-inch Wi-Fi 256GB - Rose Gold10.9-inch Wi-Fi 256GB - Sky Blue10.9-inch Wi-Fi 256GB - Green10.9-inch Wi-Fi + Cellular 64GB - Space Grey10.9-inch Wi-Fi + Cellular 64GB - Silver10.9-inch Wi-Fi + Cellular 64GB - Rose Gold10.9-inch Wi-Fi + Cellular 64GB - Sky Blue10.9-inch Wi-Fi + Cellular 64GB - Green10.9-inch Wi-Fi + Cellular 256GB - Space Grey10.9-inch Wi-Fi + Cellular 256GB - Silver10.9-inch Wi-Fi + Cellular 256GB - Rose Gold10.9-inch Wi-Fi + Cellular 256GB - Sky Blue10.9-inch Wi-Fi + Cellular 256GB - Green10.5-inch Wi-Fi 256GB - Space Grey10.5-inch Wi-Fi & Cellular 64GB - Silver11-inch Wi-Fi 128GB - Silver11-inch Wi-Fi 128GB - Space Grey11-inch Wi-Fi 256GB - Silver11-inch Wi-Fi 256GB - Space Grey11-inch Wi-Fi 512GB - Silver11-inch Wi-Fi 512GB - Space Grey11-inch Wi-Fi 1TB - Silver11-inch Wi-Fi 1TB - Space Grey11-inch Wi-Fi & Cellular 128GB - Silver11-inch Wi-Fi & Cellular 128GB - Space Grey11-inch Wi-Fi & Cellular 256GB - Silver11-inch Wi-Fi & Cellular 256GB - Space Grey11-inch Wi-Fi & Cellular 512GB - Silver11-inch Wi-Fi & Cellular 512GB - Space Grey11-inch Wi-Fi & Cellular 1TB - Silver11-inch Wi-Fi & Cellular 1TB - Space Grey12.9-inch Wi-Fi 128GB - Silver12.9-inch Wi-Fi 128GB - Space Grey12.9-inch Wi-Fi 256GB - Silver12.9-inch Wi-Fi 256GB - Space Grey12.9-inch Wi-Fi 512GB - Silver12.9-inch Wi-Fi 512GB - Space Grey12.9-inch Wi-Fi 1TB - Silver12.9-inch Wi-Fi 1TB - Space Grey12.9-inch Wi-Fi & Cellular 128GB - Silver12.9-inch Wi-Fi & Cellular 128GB - Space Grey12.9-inch Wi-Fi & Cellular 256GB - Silver12.9-inch Wi-Fi & Cellular 256GB - Space Grey12.9-inch Wi-Fi & Cellular 512GB - Silver12.9-inch Wi-Fi & Cellular 512GB - Space Grey12.9-inch Wi-Fi & Cellular 1TB - Silver12.9-inch Wi-Fi & Cellular 1TB - Space Grey32GB Space Grey32GB - Black128GB Space Grey64GB Black64GB White64GB RED128GB Black128GB White128GB RED256GB Black256GB White256GB RED64GB Black64GB White64GB RED64GB Blue128GB Black128GB White64GB Black (Demo)64GB RED (Demo)64GB Purple (Demo)64GB Black64GB White64GB RED64GB Purple64GB Green128GB Black128GB White128GB RED128GB Purple128GB Green256GB Black256GB White64GB Space Grey64GB Silver64GB Gold64GB Midnight Green256GB Space Grey256GB Silver256GB Gold256GB Midnight Green512GB Space Grey512GB Silver512GB Midnight Green64GB Midnight Green (Demo)64GB Space Grey64GB Midnight Green64GB Black64GB White64GB (PRODUCT)RED64GB Blue64GB Green128GB Black128GB White128GB (PRODUCT)RED128GB Blue128GB Green256GB Black256GB White256GB (PRODUCT)RED256GB Blue256GB Green64GB Black64GB White64GB (PRODUCT)RED64GB Blue64GB Green128GB Black128GB White128GB (PRODUCT)RED128GB Blue128GB Green256GB Black256GB White256GB (PRODUCT)RED256GB Blue256GB Green128GB Graphite128GB Silver128GB Gold128GB Pacific Blue256GB Graphite256GB Silver256GB Gold256GB Pacific Blue512GB Graphite512GB Silver512GB Gold512GB Pacific Blue128GB Graphite128GB Silver128GB Gold128GB Pacific Blue256GB Graphite256GB Silver256GB Gold256GB Pacific Blue512GB Graphite512GB Silver512GB Gold512GB Pacific BlueIMEI Number (or serial number if no IMEI)*Enter *#06# on your keypad for IMEICell Phone Number (if available)PasscodeIf 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 DamageTheft from VehicleLost DeviceTheftDate of Loss / Damage* Date Format: DD dash MM dash YYYY Place of Loss / DamagePlease provide a brief description of what happened in the space belowIf the device was lost or stolenITC Reference No.*S.A.P Case No.*Name of Police Station where reportedIf 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.)PhoneThis field is for validation purposes and should be left unchanged.