On-line Claim Notification Form

for clients of Newton Crum Insurance

Instructions as to what 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 or by phoning our claims department direct on 01424 718811 Monday – Friday 9am – 1pm & 2pm – 5pm. Whichever method you choose, please do so as soon as possible.

Fields with * are mandatory, if any are not applicable please enter N/A or 0

Policyholder Details

Policy Number:*

Title:

Assured's Full Name:*

Exact occupation and nature of business*

Additional Owners:

Email Address:

Home Telephone Number:

Daytime Telephone Number:*

Mobile Number:

Home Address:

Postcode:

Are you registered as a taxable person for VAT?

Was there any other insurance covering craft at time of loss?

Is there any finance/loan or other lien or attachment on the craft?

If so, provide details:

Craft

Class/Make:*

Builder:

Year Built:

Purchase price:

Current Value:*

Name:

Sail number:*

Hull number:*

Name and address of person or firm craft purchased from:*

Use at time of loss

State fully the purpose the craft was being used for:

If under way, names of passengers/crew:

If helm different to owner, please state their full name, address and boating experience.*

Who was helming or if accident ashore last person in charge of craft:*

Circumstances of Loss/Accident

Date it occurred:*

If exact date not known, please state date last seen undamaged and date of discovery:*

Is the craft now safe from further damage?

If not, what steps are currently being taken to safeguard her?

Time of accident:*

Exactly where:

Wind force:

If club or marina please enter name:

What happened, in detail to cause the loss/damage:*

Why did that happen:*

Is anyone else to blame?

If so, their name:

Their address:

Their Insurer:

Why it's their fault:

Was craft racing or under the preparatory signal at the time of incident?

If yes,

Was a protest made?

What was the outcome?

Please answer the following section with Yes or No and give details where requested.

Were craft/damaged items in good, sound, undamaged condition prior to accident/loss:*

If accident/loss due to gear/equipment failure, have you taken the issue up with shop you purchased from and if not, why not:*

Have the hull/foils/spars/sails been previously damaged and/or repaired whether claimed for or not:

Was there any rot/delamination/saturated wood/osmosis in the hull/decking prior to this claim date:

Damage (Hull and/or deck only)

Describe where damage is and how large an area etc.

(Best upload photos of damage and of craft overall both top & bottom, see below)

SPAR-SAIL-FOIL - loss or damage: list all items claimed for & provide full details of each item:

Retain safely all damaged items as inspection may be required.
Item Make/Model Material Age Pre-accident Condition Is it repairable at all?
Spar
If item still within makers guarantee period or Consumer Rights Act period, please confirm here:
Item Make/Model Material Age Pre-accident Condition Is it repairable at all?
Sail
If item still within makers guarantee period or Consumer Rights Act period, please confirm here:
Item Make/Model Material Age Pre-accident Condition Is it repairable at all?
Foil
If item still within makers guarantee period or Consumer Rights Act period, please confirm here:

Other loss or damage: List each item including description, make, pre-loss condition etc:

Where Can Damage Be Inspected

Name/Address of repairer you would like to use

If theft, Police station name

and address

Phone

Reference

If other craft damaged by you and your fault, please state owner's:

Name:

Address:

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 by quoting your policy number and name (most important) please do so.

Please press the browse buttons below to select the file(s) you wish to submit
(max size 2MB each, 8MB total & only JPG images are allowed):

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 general offence of fraud in 3 sections:

  • By false representation
  • By failing to disclose information
  • 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 gain for him/herself. 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. PLEASE NOTE - Insurers share claim information with each other to prevent fraudulent claims and in the event of a claim may search databases and registers to exchange claim details with participating insurers and services.

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 supression or concealment of the material fact has been made, the right to recover under this policy shall be absolutely forfeited. Date and time as per transmission header, policyholder's confirmation of agreement to this declaration by re-confirmation of his/her name below

Please re-confirm your name below and please check that you have answered all questions. We will reply to you with the settlement instructions and advice. Now please press submit.

Policyholders name:*

IMPORTANT - Privacy & Personal Data.
In order to process all request/insurance/claim/amendment we require your consent to access your personal data as currently held or requested here. Full details at newtoncrum.com "Privacy Policy" or phone 01424 718800 for paper copy. Please do not proceed unless you have read this and consent thereto.

A first class plus/5 star plus service. Absolutely super help from Mrs Ransom. Best Insurance service I have ever had (for all areas of insurance).