Online Claim Submission Form "*" indicates required fields 1Policy Details2Pet Details3Claim Details4Document Uploads5Disclosure 1. Policy DetailsPolicy number* Policy Product* Pawpaw BobSure Cat and Dogsure Exotic Pets Rainbow Paws Pet Heaven Policy holder name* ID Number* Phone number* 2. Pet DetailsPet name* Date of Birth* MM slash DD slash YYYY Breed* Pet type* Cat Dog Gender* Male Female 3. Claim detailsType of claim* Accident Illness First claim?* Yes No Name of treating vet* Would you like us to pay your vet directly?* Yes No Date of treatment* MM slash DD slash YYYY Date symptoms first manifested?* MM slash DD slash YYYY What was the Vet's diagnosis?*Has the condition been treated in the last 30 days?* Yes No Did the illness/injury result in the death of the pet?* Yes No Date of death* MM slash DD slash YYYY Are you currently insured or have any other insurance policies in place which may cover this risk?* Yes No Please advise who you are covered with* What is the total amount of this claim?* 4. Please upload your claim documentsDetailed invoices/Vet bill* Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 32 MB. Full description of accident report*Date of accident* MM slash DD slash YYYY First Vet visit for accident* MM slash DD slash YYYY 5. DisclosureClaim Declaration* I agree to the following:I understand that I am fully bound by my conscience in making this statement and that any misrepresentation of the facts constitutes fraud. I have no other insurance on the pet claimed for above. I hereby agree that the Insurers of the Policy may take over and conduct this prosecution for their own benefit of any claim for cover or otherwise and shall have full discretion in the conduct thereof.Signature of Policy Holder*Your Email Address* NameThis field is for validation purposes and should be left unchanged.
