Make a claim today Kindly fill out the form so we can help initiate the claim for you Blank Form (#4)First NameLast NamePhone/MobileEmail AddressPolicy NumberIs this a claim or a request?– Select –ClaimRequestSelect claim categories– Select –Retail LifeCorporate LifeGeneral Insurance ClaimsSelect type of claim– Select –MoneyMarine (Cargo and Hull)Fidelity GuaranteeMachinery BreakdownPlant All RisksGroup Personal AccidentGoods in TransitAll RisksBurglaryFuneral ExpensesPermanent DisabilityCritical IllnessDeathCash BackCool OffSurrenderedFire (Combined policy and Industrial All Risks)MotorLoss of JobPart-withdrawalCancellationSelect type of request– Select –MoneyMarine (Cargo and Hull)Fidelity GuaranteeMachinery BreakdownPlant All RisksGroup Personal AccidentGoods in TransitAll RisksBurglaryFuneral ExpensesPermanent DisabilityCritical IllnessDeathCash BackCool OffSurrenderedFire (Combined policy and Industrial All Risks)MotorLoss of JobPart-withdrawalCancellation I hereby authorise emPLE to communicate with me on the given contact details for my Insurance needs. Please note that this information is confidential and is not disclosed to anyone.Submit Form