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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 following information:*
  • 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?*
  • Please provide the following information of the person(s) responsible for loss or damage:*
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  • Statement of claim

  • Please provide information of the item(s) being claimed:*

  • Kindly note that your claim may be subject to a policy excess as shown on your Policy Schedule, as well as any other deductions, including for example betterment.

  • State the item being claimed and respective amounts*
  • Upload File Checklist:*
  • Upload File Checklist:*
  • Upload File Checklist:*
  • Upload File Checklist:*
  • Upload File Checklist:*
  • Upload File Checklist:*
  • Upload File Checklist:*
  • Upload File Checklist:*
  • Upload File Checklist:*
  • Upload File Checklist:*
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  • Bank Account Details

  • Please provide bank details to facilitate any claim payments

  • Declaration

  • I/we hereby declare that, after checking all details, the above information and statements are, to the best of my/our knowledge and belief, correct and complete. I/we understand that in the event of an incomplete and/or non-disclosure of material information, Mapfre Malta p.l.c. reserves the right to repudiate the claim. Furthermore, I/we declare that I/we have not withheld any information relevant to the claim and assume full responsibility for the statements being made.

    If the answers to all or any of the above questions have been written by others at my/our dictation or instruction I/we confirm that I/we have read those answers and that they are correct and that such person completing this form on my/our dictation or instruction for this purpose will be regarded as my/our agent.

  • 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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  • PERSONAL DATA PROCESSING
    If you would like to know more about how Mapfre Malta p.l.c. processes your personal data, please refer to the following link: www.mapfre.com.mt/privacy-policy/.

  • 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.

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