Property damage claim

Form HM-PD-3 · Fields marked * are required

1. Your policy

Policy number Claim reference

2. About you

Full name TelephoneEmail

3. The loss

Date of loss (DD/MM/YYYY) Cause of loss What happened?

Can you still live in the property?YesNo

Emergency repairsPlumber attended on 14 August

4. Amount claimed

Building repairs (£)Contents (£)Less excess (£)Total claimed (£)

5. Declaration

I confirm the information on this form is true and complete. I understand that a false or exaggerated claim may be refused.

Signature

Date

6. Payment

We pay settlements by bank transfer to the policyholder only.

How we use your information

We use the details on this form to handle your claim and to prevent fraud. We may share them with loss adjusters, contractors and other insurers. See harbourline.example/privacy.