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  • Home Insurance Claim Form

  • IMPORTANT NOTES

    Insurers, their Agents and Insurance Associations share information with each other to prevent fraudulent claims and for underwriting purposes. In the event of a claim, some or all the information you supply on this form and the proposal form together with other information relating to the claim may be provided to other Insurers, their Agents and Insurance Associations.

    ALL RELEVANT QUESTIONS MUST BE FULLY ANSWERED

  • Personal Identification Type
  • Valid to
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date and time of loss/damage:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Were the premises occupied at the time of loss or damage?*
  • Date when last occupied*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Are you the sole owner of the lost/damaged buildings or contents?*
  • Please state the names of other interested parties*
  • Are there any other insurances covering the property which has been lost or damaged?*
  • Please state the name of the Insurer and policy number cover*
  • Have you previously suffered loss or damage from a similar cause*
  • Were the police notified of loss and/or theft?*
  • Date police notified*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Has the damage been caused by a person other than yourself?*
  • If applicable, please provide name and address of person(s) responsible for loss or damage*
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  • Statement of claim

  • State the item being claimed and respective amounts*
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    • Check what documents you may need 
    • Submission of: Photos of damaged items being claimed Technical report/quotation submitted by the repairer/technician/retailer etc. Police Report (if applicable) Water Tracing Agents / Water Leak Repairs report (if applicable)
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  • Signatures

  • I/We hereby declare that the above information and statements are, to the best of my/our knowledge and belief, correct and complete.
  • Date
     - -
    2 digit day, 2 digit month, 4 digit year
  • Is the device that you are using to complete this claim form touch capable (ex: Mobile phone/tablet)*
  • Please use the space below to provide your signature directly
  • Signature of policy holder*
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  • Mapfre Malta p.l.c. (C‑5553) is authorised by the Malta Financial Services Authority (MFSA) to carry on both long‑term and general business under the Insurance Business Act, Cap. 403 of the Laws of Malta. Mapfre Malta p.l.c. is regulated by the MFSA.

  • Please provide bank details to facilitate any claim payments

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