Insurance Claim Form
Open a claim in three steps, with the policy details, a dated account of the loss, and the documents attached, so nothing is sent back for a missing field.
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- Fields
- 22 questions across 3 pages
- Layout
- Classic, every question on one page
- Theme
- Chambers, switchable in the preview
- Updated
- 18 September 2026
Categories
- Finance form templates
- Claim Forms
- Finance Forms
- Application Forms
Ideal for
- Insurers
- Brokers
- Claims handlers
- Loss adjusters
Best used in
- Insurance
- Financial services
- Fleet management
About this template
Claims get returned for missing information, and every return adds a week. This form is arranged as three steps that match how a claim is actually assessed: who holds the policy, what happened, and what proves it. Nothing in the third step can be filled in before the second, so the order is not just presentation.
The incident step is where claims usually go thin. It asks for the date and the time separately, the address where it happened rather than the address on the policy, and an account written in the order events occurred including anything done to limit the damage, which is the detail that decides several kinds of claim on its own. The police question and its reference number sit together, so a crime number is never remembered a fortnight later.
The documents step splits the uploads into photographs, receipts or estimates, and any official report. Three labelled fields get the right files far more reliably than one box marked attachments, and an assessor opening the claim can see immediately what is missing.
The declaration and signature close it. Change the claim type list to the products you actually underwrite, and if your process needs a broker or an adjuster reference, add it beside the policy number where somebody is already looking it up.
Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.
Fields in this template
- Policyholder name*Name
- Policy number*Short text
- Date of birthDate
- Email address*Email
- Phone number*Phone
- Address on the policy*Address
- What are you claiming for?*Dropdown
- Date of the incident*Date
- Approximate timeTime
- Where did it happen?*Address
- Describe what happened*Long text
- Estimated value of the lossNumber
- Was this reported to the police?*Single choice
- Crime or reference numberShort text
- Details of anyone else involvedLong text
- Is this covered by another policy?Single choice
- Photographs of the damageFile upload
- Receipts, invoices, or estimatesFile upload
- Police or medical reportsFile upload
- Please confirm*Multiple choice
- Signature*Signature
- Date signed*Date
Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.
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Frequently asked questions
- What information is needed to submit an insurance claim?
- The policy number and policyholder details, the date, time and location of the incident, a factual account of what happened, an estimate of the loss, any police or reference number, supporting documents, and a signed declaration. This template collects all of them in that order.
- Why does the form ask for the time as well as the date?
- Because the time is frequently what a claim is checked against, whether that is a camera recording, a weather record, a security log or another party's account. A date alone leaves the most verifiable detail out of the file.
- What documents should be attached to a claim?
- Photographs of the damage, receipts, invoices or repair estimates showing value, and any police or medical report. The template gives each of those its own upload field, because a single attachments box reliably produces one photograph and nothing else.
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