Claim Notification

About Our Digital Form

The Purpose of This Digital Form
Welcome to iTOO's secure digital claims form. This form is used to notify iTOO of:

A loss that has already occurred (a claim)
An event which may lead to a claim - if required by your policy (a circumstance)

When Not To Use This Form

Should you have a Cyber, Pollution Spillage or Kidnap & Ransom emergency or require Classic Car roadside assistance, please call us on 0861 00 4866 (or +27 11 351 4734) instead of proceeding with this form.

What You Will Require To Complete This Form

Details of the claim/circumstance
Any applicable supporting documents, such as:

Affidavit or witness statements,
Artinsure lost items form,
Correspondence,
Contracts,
Policy Schedule,
Video or photographic evidence of incident...

If You Need Our Help
For help completing this form, please email us at digitalsupport@itoo.co.za

Your Security Matters to Us
We've transitioned to secure digital forms that are encrypted while being completed using SSL. Unlike PDFs, this means that the access to your information is strictly controlled, and cannot be circulated. It also means that information can easily be deleted once it is no longer required.

About You

Please confirm your role:

I am a BrokerI am a Policyholder

Although you may continue, we strongly recommend that you contact your broker (and inform them in writing), so that they can advise and complete this process on your behalf.

HIDDEN

Case Origin	Status	Time of Event	Policy ID
	Broker ContactID

Broker Contact Details

Broker Full Name

Full name of your broker (eg: Jim Singh)

Broker Email

Broker's email address (eg: jim@gmail.com)

Additional Broker Email

Additional broker email addresses you want included in the notification (eg: placement team)

Policy Details

Policy Number

iTOO policy number related to claim notification

Policy Holder Name

Name of policyholder

Insured Member/ Subsidiary/Branch (if applicable)

Policyholder Contact Details

Policyholder Contact Full Name

Contact at the insured dealing with the claim notification

Policyholder Contact Email

Policyholder Contact Number (single number incl. country code)

Claim / Circumstance Details

Broker Reference Number (if applicable)

Subject

Description of Loss / Potential Loss

Date of Loss

Indicative Claim/Loss Currency

Indicative Claim/Loss Amount

Has a Summons / Regulatory Body Complaint / Letter of Demand been Received?

YesNo/ Not Applicable

Please Select Which Have Been Received (You Can Select Several)

Date the Above was Received (Earliest if Several)

Supporting Documents

Please Upload any Supporting Document (up to 10 documents not exceeding 25mb in total)

To upload several files, please click 'add another response' on the right to add up to a maximum of 10 files. Should your documents be larger than allowed, please complete the process and these will be requested later.

Additional Comments

Are there any additional comments you wish to add?

You can add details of another claim/circumstance (up to a maximum of 3), by clicking 'Add another response' below.

I/we warrant that the answers given are true and correct to the best of our knowledge and all details provided on this form are done so honestly and in good faith. This means that iTOO Special Risks (Pty) Ltd has been made aware of all important information and that any incorrect information may mean that the claim may be rejected, and the policy cancelled.

In order to provide you with insurance and insurance-related services, we have to process your personal information to comply with applicable laws. We will share your personal information with other insurers, industry bodies, credit agencies and service providers. This includes information about your insurance, claims and premium payments. We do this to provide insurance services, prevent fraud, assess claims and conduct surveys. We will treat your personal information with caution and have put reasonable security measures in place to protect it. By submitting this form, you agree to the processing and sharing of your personal information.

AgreeDisagree