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Submit Claim
1
Policy Details
2
Pet Details
3
Claim Details
4
Document Uploads
5
Disclosure
1. Policy Details
Policy number
*
Policy Product
*
Pawpaw
Cat and Dogsure
Pawmed
Exotic Pets
Rainbow Paws
Shu
Policy holder name
*
ID Number
*
Phone number
*
2. Pet Details
Pet name
*
Date of Birth
*
MM slash DD slash YYYY
Breed
*
Pet type
*
Cat
Dog
Gender
*
Male
Female
3. Claim details
Type of claim
*
Accident
Illness
First claim?
*
Yes
No
If yes, please provide full vet history of pet.
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 documents
Vet history
*
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 32 MB.
Detailed invoices/Vet bill
*
Drop files here or
Select files
Accepted file types: jpg, 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. Disclosure
Claim 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
*
Name
This field is for validation purposes and should be left unchanged.
