Customer Name(Required) Claim Reference Number(Required) Insurer(Required) Policy Number(Required) Claim Handler(Required) Claim Handler Email(Required) Central Forwarding Email(Required) Park Name if Applicable Make and Model of Home Age of Home Date of LossDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Risk Address(Required) Address Line 1 Address Line 2 Town/City Post Code Tick if Correspondence Address is the same as the Risk Address? Yes Correspondence Address(Required) Address Line 1 Address Line 2 Town/City Post Code Landline NumberMobile Number(Required)Other Phone NumberCustomer Email Vulnerabilities and Special Instructions(Required)Peril(Required) Claim Details(Required)Policy Excess £(Required)