Seguro de Multirriscos Comércio e Indústria

Av. Kenneth Kaunda, 518, Maputo

Claims Participation

Name of Beneficiary *

Address *

Beneficiary's telephone number *

Location of the accident *

Location *

Province *

District *

Date of Claim *

Did the fire department intervene? *

If the fire department was absent, what was the reason? *

Was arson suspected? *YesNo

Was the place uninhabited? *

If there are joint owners of the property, please indicate their names: *

Authority to which it was reported *

Police Station *

Brigade/Agent *

Process nº *

Attach proof of the process *

No file chosen

Place where the glass was installed (shop window, door, window display, etc.) *

Glass measurements *

Person responsible for the claim (Name and address) *

Name of Owner/Victim *

Address *

Profession *

Marital Status *

Age *

Family degree/relationship? *

Witnesses - Name/Address/Profession *

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