New LUIB claim LUIB Claim Form Kindly confirm the following information in order for us to proceed with your claim as soon as possible: Broker:AnishaHeleneJabulaniLetiziaDamage Report, Repair or Salvage?* Damage Report Repair Salvage Max Auth Amount Device Replacement Value* Sum Insured* Claim #* First Name* Last Name* Phone NumberYou can add more than one number if needed.Email Address* Risk AddressPlease add the address, and collection notes, if needed: Eg: Please hoot at the gate, intercom broken.Additional Contact Information:Excess Amount* Device Make Device Model Device Capacity Colour Dual-sim? No Yes Damage / Problems Experienced / Notes
