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Claim Form for Eviction/Abscondment

Provide your policy number*

Confirm the Tenant Name and Surname*

Confirm the Owner Name and Surname*

Is the tenant still in the property?

YES

NO

DECLARATIONS

That the above-mentioned information is correct and that I have not acted against the terms and conditions of the policy.

Signature*

Sign in the box or use the keyboard to type.

Signature field is empty.

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