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    Contractors Plant-Claim Form

    Uploaded by

    Crawford Boyd
    This document is a claim form for contractors plant and equipment insurance. It collects details about the policyholder, the damaged equipment, how and when the damage occurred, any witnesses, estimated repair costs, and documentation to support the claim such as photos, invoices or estimates. The policyholder must sign declaring the accuracy of the information provided.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Contractors Plant-Claim Form

    Uploaded by

    Crawford Boyd
    21 views3 pages
    This document is a claim form for contractors plant and equipment insurance. It collects details about the policyholder, the damaged equipment, how and when the damage occurred, any witnesses, estimated repair costs, and documentation to support the claim such as photos, invoices or estimates. The policyholder must sign declaring the accuracy of the information provided.

    Original Description:

    Premco CPE claim form

    Original Title

    Contractors Plant-claim Form

    Copyright

    © © All Rights Reserved

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    This document is a claim form for contractors plant and equipment insurance. It collects details about the policyholder, the damaged equipment, how and when the damage occurred, any witnesses, estimated repair costs, and documentation to support the claim such as photos, invoices or estimates. The policyholder must sign declaring the accuracy of the information provided.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    21 views3 pages

    Contractors Plant-Claim Form

    Uploaded by

    Crawford Boyd
    This document is a claim form for contractors plant and equipment insurance. It collects details about the policyholder, the damaged equipment, how and when the damage occurred, any witnesses, estimated repair costs, and documentation to support the claim such as photos, invoices or estimates. The policyholder must sign declaring the accuracy of the information provided.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Contractors plant & equipment

    Claim form

    Policy number      

    Name of business(es) insured      

    Correspondence address inc. post code      

    Name of the director / person handling the


         
    claim on your behalf

    Contact email address      

    Contact telephone number      

    DETAILS OF CLAIM

    Date of occurrence      

    Time of occurrence      

    Place of occurrence      

    Nature of work being carried out by the plant /


         
    equipment
    Name of person in charge of the plant /
         
    equipment
    Address of person in charge of the plant /
         
    equipment
    Contact telephone number of the person in
         
    charge of the plant / equipment
    Was the person in charge of the machine
         
    employed by you?

    Please detail the operator’s license or permit      


    Was the person in charge of the plant /
         
    equipment operating it with your consent?
    Name of operator’s employer if not employed
         
    by you
    Please explain how the loss or damage occurred
         

    Name of any witness to the loss / damage      

    Address of any witness to the loss / damage      

    Contact telephone number of any witness to the


         
    loss / damage

    iConstruct contractors insurance for construction professionals underwritten at Lloyd’s


    Premier Commercial Limited – Email: [email protected] Telephone: 0845 111 0125
    Contractors plant & equipment
    Claim form

    DETAILS OF THE PLANT / EQUIPMENT

    Make      

    Model      

    Age      

    Date of purchase      

    Value      

    Registration / identification number      

    Name of owner      

    Address of owner (if not the insured)      

    Is the machine hired in / out by the insured      

    Name of hire company / hirer      

    Address of hire company / hirer      

    Contact telephone number of hire company /


         
    hirer

    LOSSES OCCURRING DUE TO THEFT OR MALICIOUS DAMAGE

    Name of person who discovered the loss      

    How was the loss discovered      

    How was the plant / equipment immobilised or


         
    secured from theft or malicious damage
    Was a hydraulic lock or other anti-theft device
         
    fitted to the plant / equipment (detail)

    Please provide details of site / premises security      

    When was the loss reported to the Police      

    What is the Police crime reference number      

    Name of Police office and number      

    Police station name      

    Police station address      

    Have any steps been taken to recover the plant /


         
    equipment

    LOSSES OCCURRING DUE TO DAMAGE

    How did the damage occur      

    Address where damaged plant / equipment can


         
    be inspected

    What is the estimated cost of repairs      

    iConstruct contractors insurance for construction professionals underwritten at Lloyd’s


    Premier Commercial Limited – Email: [email protected] Telephone: 0845 111 0125
    Contractors plant & equipment
    Claim form

    LOSSES OCCURRING DUE TRANSIT

    Name of carrier      

    Address of carrier      

    Method of conveyance of plant / equipment      

    How was the plant / equipment packaged /


         
    secured

    Conditions of carriage      

    Was the damage as a result of loading or


         
    unloading

    Who was responsible for loading or unloading      

    Conditions of carriage      

    Please attach YES - X NO - X


    Conditions of hire
    Purchase receipt(s)
    Estimate for repairs
    Valuation supporting documentation
    Conditions of carriage
    Photographs

    I/ we declare that the statements detailed in this submission are true and accurate to the best of my/our belief
    Authorised signature      

    Name of signature      


    Position      
    Date of signature      

    Please keep a copy of this submission for your own records

    iConstruct contractors insurance for construction professionals underwritten at Lloyd’s


    Premier Commercial Limited – Email: [email protected] Telephone: 0845 111 0125

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