On-line Claim Notification Form
for clients of Newton Crum Insurance


Instructions as to what immediate action you must take in the event of theft, accident or damage are set out on the YELLOW form stapled to your policy or renewal receipt.

You may provide initial details either by submitting the following form on-line, by fax 01424 445043, or by phoning claims direct on 01424 718811. Which ever method you chose, do NOT delay.



Policyholder Details

Policy Number:
Full Name:
Occupation:
Day Phone No:
Day Fax No:
Home Phone No:
Home Fax No:
Home Address:
Post Code:
E-mail Address:
Are you registered as a taxable person for VAT?
Was there any other insurance covering this craft at time of loss?
Were you helming or last person in charge of craft prior to loss?

Craft Details

Class:
Builder:
Year Built:
Current Value:
Name:
Sail Number:
Hull Number:
Hull Material:
Spar Material:

Use at Time of Loss

State fully the purpose the craft was being used for
If under way, names of passengers/crew

Circumstances of Loss-Accident

Date It Occurred
Exactly Where?
Wind Force
If Club or Marina: Name:
What Happened?
Why Did That Happen?
Is Anyone Else To Blame?
If so, Their Name
    Their Address
    Their Insurer
    Why it's Their Fault
Detail Your Loss-Damage
Where Can Damage Be Inspected
Name/Address or Repairer You Would Like To Use
If Theft, Police Station: Name:
    Address:
    Phone:
    Reference:
If other craft damaged by you & your fault please state that owners:
    Name:
    Address:
    Their Insurer:
Photos of the damage usually speeds settlement so if you have facilities to take photos and submit them by jpg or similar with this form or separately quoting your policy number and name (most important) please do so.

Attach your Photo(s).

Please press the browse button below to select the file(s) you wish to submit:



Any other information you feel will be helpful to insurers please state below:
If you have any specific questions please state them below:

Important - please read before completing/submitting form The Fraud Bill sets out provisions for a general offence of fraud in 3 sections:

  1. by false representation
  2. by failing to disclose information
  3. by abuse of position

Clause 2 makes it an offence to commit fraud by false representation, i.e. the intention of making a gain or causing a loss or risk of a loss to another. The gain or loss does not actually have to take place. Clause 3 makes it an offence to commit fraud by failing to disclose information to insurers in order to make a gain for him/her self. The Bill complements the utmost good faith obligations of the insured/proposer per sections 18(1) and 20(1) of the Marine Insurance Act 1906. Fraud will be prosecuted as well as negating the claim.

I/We declare that the whole of the statements made on this claim form are true in every respect and I/We agree that if any false or untrue statement or any suppression or concealment of material fact has been made, the right to recover under this policy shall be absolutely forfeited. Date & time as per transmission header, policyholder's conformation of agreement to this declaration by re-confirmation of his/her name below:

Policyholder's Name

CHECK BEFORE SUBMITTING THAT YOU HAVE ANSWERED ALL QUESTIONS.

We will reply direct to you with settlement instructions & advices, now please press Submit

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Newton Crum Insurance Agents Ltd, Droxford House, Charles Road, St. Leonards,
Sussex, TN38 0JU
Authorised and regulated by the Financial Services Authority

Updated 06 March 2008 S