è Sure Direct Claim Form

Please fill out the form below as accurately as possible.
All fields in red are mandatory.

Customer ID No		Customer Name
Telephone Number		Email Address

Date of Collection		Collection Address




Date Delivered		Delivery Address





Level of Cover

Removal Co-ordinator

Removal Contractor

Following information is required as an attachment via email to: leane.fellows@suredirect.co.uk
Copy of Insurance Quote
Copy of Insurance Cert.

Nature of Complaint	Acidental Damage	Loss

Details of Claim


Please ensure all insurance documents are read before submitting claim for relavant exclusions which may apply. Failure to do so may result in delay of claim being processed.