Insurance Claim Form

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TEST 13Cambridge IELTS Trainer 2 · Questions 1–10

Insurance Claim Form

Complete the form below.

Write ONE WORD AND/OR A NUMBER for each answer.

INSURANCE CLAIM FORM

ExampleClient details
NameGreg Williams
Policy reference:
1
Address:
2 Street, Northbridge
Phone number:
3

Description of damage

Date of incident:
Sunday, 17th June
Cause of incident:
the house was damaged during a 4
Items client is claiming for:
a pair of child's 5a new 6a torn 7repairs to the door of the 8

Builder dealing with damage

Full Name:
Steven 9
Client to send in photographs of damaged 10 before building work starts
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