Business Interruption Insurance Claim Form
Policy & Insured Details
Policy Number
Insured Name
Contact Person
Contact Number
Email
Business Address
Incident Details
Date of Incident
Time of Incident
Location of Incident
Description of Incident
Cause of Interruption
Period of Interruption (From)
Period of Interruption (To)
Loss Details
Estimated Financial Loss
Description of Loss Sustained
Additional Comments
Supporting Documentation
Upload Relevant Documents
Declaration
Name of Person Completing Form
Date