Report A Claim

Allegiance is committed in assisting our clients in their claim process. Please notify us soonest for any claim as late reporting to the insurer may jeopardize the claim admissibility. We endeavor to revert within 1 working day.

Please assist to provide the following of details.

Insured Name:
Contact Person:
Telephone:
Email:

Claimant Name:

(if different from Insured)

Telephone:
Email:
Type of Insurance:
Date of Loss:
Description of Loss:
Brief description of Incident:
Estimated Loss:$

(Important for Property, Liability, Marine Cargo Claim)

Witness's Name:
Witness's Telephone:
Remarks
I have read and agree to the Terms and Conditions. Please read our Terms & Conditions before submitting this form.