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:AnishaClaimsHeleneJabulaniKelebogile MatlabeKouga Local MunicipalityLetiziaNewcastle MunicipalitySesi Goodness MatsonyaneDamage Report, Repair or Salvage?* Damage Report Repair Salvage Max Auth AmountDevice 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 MakeDevice ModelDevice CapacityColourDual-sim? No Yes Damage / Problems Experienced / Notes
