Claim form

I/We and our Property Manger do solemnly and sincerely declare:
- That the information supplied on this Claim Form and Statement of Claim is true in every respect.
- I/ We understand that the claim may be refused if information is withheld, false, misleading or concealed.
- That there was no other insurance covering this loss current at the date of this incident
- I / We acknowledge that this Claim Form is a Legal Document and as such may be used in any legal proceedings resulting from this claim.