Company Reg. No. : 192300014M

20 McCallum Street#09-01 Tokio Marine Centre
Singapore 069046
Tel : (65) 6221 6111 Fax : (65) 6225 9887
Email : tmis@tokiomarine.com.sg
Website : www.tokiomarine.com.sg

Fire - Property Claim Form

Fire and GA Claims Department - Fax: 6225 9887

The issue of this form is not to be taken as an admission of liability by the Insurers. It is important that a complete answ er begiven to every question. If insufficient space is provided for your answers, please attach a separate sheet.
Name of Policyholder :Policy No :Tel No :Residential Address:

Email :
Contact Person :Business Address :Tel No :Occupation/Business :State fully what happened :Date :

Time:

Place of occurrence :Nature of loss or damage :Who discover this loss/damage?

Date discovered:

Do you know who cause this damage: Yes

No. If Yes please state name and address of this person :The Police must be informed immediately if the property has been lost, stolen or maliciously damaged. Please attach a cop y ofpolice report if applicable. Name of police station report was lodged:
Were the premises occupied at the time of the loss? Yes

No

If No, give date and time they were last occupied and by whom :If entry was illegal, how and between what hours it happened?
State if rooms were ransacked. Yes

No

If Yes, give details

If Yes, by whom:(1)Quantity(2)
Description

(3)

(4)

DateAcquired

CostPrice

(5)

(6)

Value at the time Amount ofof loss
damage(Replacement
sustained
Cost, if Building)

(7)

(8)

Value ofsalvage

Net amount of claim ie
difference between
amounts in (6) & (7)TOTAL :
What is the total value at the time of the loss of all the property insured by this policy ?
Do you own the property? Yes No If No, give name and address of the owner:
Is the property subject to a hire purchase or loan agreement? Yes

No. If Yes, give name of the finance or lending

company, their address and agreement number:
Was the property on loan or hire to another party? Yes

No. If Yes, give name and address of party?

Is any other party interested in the property? Yes

No. If Yes, give name of party and extent of interest :Is there any other insurance on the property? Yes

If Yes, provide details as follows:
If interest covered is different fromSum Insured
that covered by our policy, give details

CompanyPolicy NoNo2

Have you ever before sustained loss of this nature? Yes

No If Yes, give details:

Have you ever made a claim of this nature on us or on any other insurer or underwriter? Yes

No

If Yes, give details:

Declaration: I/We hereby declare that these particulars are true to the best of my/our knowledge and belief and I/we have in nomanner caused the loss nor by any fraud or misrepresentation sought to benefit thereby. I/We accept that insurers would be atliberty to deny liability in part or in full if the above written answers are false or inaccurate in any aspect
Notice for Personal Data Protection Policy
By signing this form:i) I/We acknowledge and consent to TMiS collecting, using, processing and disclosing to third party service providers and/orintermediaries, within or outside Singapore, my/our personal data for the purpose of processing and servicing my/ourpolicies/claims;ii) I/We declare and confirm that I/we have obtained the consent of the person(s) and/or nominee(s) named herein, whereapplicable, and that he/she/they has/have authorized me/us to disclose their personal data and to give consent on their behalf
for the above collection, use, process and disclosure; andiii) I/We acknowledge the detailed Privacy Policy Statement, governing the above, posted at www.tokiomarine.com.sg.

Signature & Company Stamp of Insured

DateName

Designation::

NRIC NO:NOTES
1. Wherever possible, claims should be accompanied by Builders’, Architects’ or Repairers’ estimates.
2. A Fire Policy being a contract of Indemnity only, no profit or any kind should be included in the amount claimed.
3a) Claims in respect of Building should be based upon the cost of restoring them to the condition they were in at the time of the loss.
Contemplated improvements must not be included.
b) Claims for Furniture, Fittings, Machinery, Tools, Electrical Appliances, etc., must not exceed their value at the time of the loss; that is,after due allowance has been made for age, wear and tear and depreciation during the time they have been in use. Where appropriate,
the claim will be based on the cost of repairs or of restoration.
c) Claims for Stock-in-Trade should be based on values at the time of the loss after deduction of all discounts or allowances. Dueallowance must be made for out of date and unsaleable stock.
Please mail duly completed claim form to:
Tokio Marine Insurance Singapore Ltd, 20 McCallum Street, #09-01, Tokio Marine Centre, Singapore 069046
Fire and GA Claims Department, Fax: 6225 9887

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