Insurance Claim Form

Please use the form below to make a claim on an existing policy with Adrian Shaw Insurance Consultants. On receipt of the form we will call you as soon as possible to help discuss your claim.

If you would prefer to talk to us first, please use our FREE Call-back Request and we will phone you back at a time that is convenient for you.

Your I.P. address (recorded for security purposes): 38.107.191.84

Claim Details:
(Fields marked are mandatory)*
Title: *		Company:
Forename: *		Address 1: *
Surname: *		Address 2:
Phone: *		Town: *
Fax:		County:
Email: *		Post Code:
Policy No: *		Policy Type: *
Comments: (optional)
	DATA PROTECTION NOTICE: This notice explains how we treat the information that you provide us when you use this site. It also aims to assure you of our commitment to the requirements of the Data Protection Act 1998 in relation to the processing of any personal data we obtain from you. What is 'Personal Data'? Where you have requested action from this site, you may be asked for information that personally identifies you (Personal Data), enabling us to contact you to provide you with a service or advice that you have requested. How does this site collect Personal Data? Our site collects data only from the information that you provide on this form. What is Personal Data used for? Personal data collected on this site may be used to: 1. Provide you with the advice or services that you have requested 2. Provide you with a personalised view of information on this site, which may be of special interest to you and/or your company. 3. Disclose your information as required by law. 4. We will not sell, rent or trade personal information to any third party for their own marketing purposes. Removal of your Personal Data At any time you may request that information about you (collected from this site) be deleted from our records, by emailing or telephoning us. Contacting Us You will find our contact details on this website by visiting the 'Contact Us' links. We reserve the right to update this notice from time to time in response to changing legislation or business issues. In such an instance a revised notice will be posted on this page. Privacy Policy For further information on how we store and use your information, please refer to our Privacy Policy which is also available on this site. * I have read and agree to the terms described in the Data Protection Notice. Please see our Privacy Policy for further information.

Insurance Claim Form

Claim Details: