CLAIM FORM

Step 1 of 3

Comments
This field is for validation purposes and should be left unchanged.
NOTE: Our claims process starts with the completion of this form.

All lost/stolen Mobile Devices must be reported to the SAPS within a maximum of 48 hours from discovery of the loss.

This form must be completed and submitted within 30 days from the date of loss.
ID Number*
Cell Number*

Device Details
Type of Loss / Damage*
- Accidental Damage
- Theft from Vehicle
- Lost Device
- Theft
Date of Loss / Damage*
Place of Loss / Damage
Please provide a brief description of what happened in the space below
Please upload any documents required for your claim submission
Copy of ID
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.

Allowed file types: jpg, jpeg, gif, png, pdf
Affidavit
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.

Allowed file types: jpg, jpeg, gif, png, pdf
Other docs (Photo of phone box) and (iStore Statement)
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.

Allowed file types: jpg, jpeg, gif, png, pdf
If the device was lost or stolen
ITC Reference No.*
S.A.P Case No.*
Name of Police Station where reported
If the device was stolen from a vehicle
Fax or email a copy of the invoice for repairs to your vehicle to 086 505 6721 / claims@adminplus.co.za.
How was entry gained?
Claims Declaration*
I hereby agree that:
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 property 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.

(Please complete a separate form for each item being claimed.)

I/We hereby declare that all the information declared above is true in every respect and that I/We have not withheld any relevant information and I/We will assist with any additional information that is required to finalise this claim.
I/We hereby authorise Adminplus/the Insurer to carry out any checks required to validate my/our claim including but not limited to ITC checks, Beacon and Billings information, last Usage, CCTV footage and SAPS information.
I understand that I am fully bound by my conscience in making this statement and any misrepresentation of the facts constitutes fraud. I have no other insurance on the property claimed for above.
I hereby agree that the insurers of the policy may takeover and conduct any prosecution for their own benefit of any claim cover or otherwise and shall have full discretion in the conduct thereof.
Collection & Delivery
Collection address/Store
Delivery address/Store

CLAIM FORM

Step 1 of 3

Policy devices

Device Details

Please upload any documents required for your claim submission

If the device was lost or stolen

If the device was stolen from a vehicle

Collection & Delivery