Contractors All Risk – Claims Advice Form InsuredBryte Claim NoPolicy NumberInsuredResponsible person on site and contact numbersNamePhoneCellphoneEmail Please enter your email if you would like a copy.Parties to the contractContract value (including value of free issue materials)Contract numberDescription of contractSite physical addressCodeContract commencement date DD slash MM slash YYYY Expected contract completion date DD slash MM slash YYYY Who was responsible for arranging the Project Insurance (Contract works claim)Who was responsible for arranging the Public Liability Insurance (PL Claim)Please attach an extract from the contract/subcontract document to verify this fact Drop files here or Select files Max. file size: 256 MB, Max. files: 10. Time of damage Hours : Minutes AM PM AM/PM Date of damage DD slash MM slash YYYY Attach digital photographs, if available Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 30 MB. How/Why did the loss/damage occur? (cause eg. Act of God (Storm etc.)/Defective design/Defective workmanship)Name of party responsible for causing loss/damage (i.e N/A (Act of God) Insured/Contractor/Subcontractor/Consulting engineer/Employer)Contact number of party responsible for causing loss/damage (i.e N/A (Act of God) Insured/Contractor/Subcontractor/Consulting engineer/Employer)Name of party who suffered loss/damageContact number of party who suffered loss/damageEstimated cost of repair/replacementWorks ClaimAttach documentary evidence (including digital photographs if available) of the above costs and extracts from the Bill of Quantities/the original quotation which detail the costs allowed, for the items now being claimed. Drop files here or Select files Max. file size: 256 MB, Max. files: 10. Police station and reference (Theft claims only)Signed on behalf of the InsuredNameCapacityDate DD slash MM slash YYYY Protection of Personal Information Act (POPIA)All personal information collected on this form will be processed in accordance with our privacy statement. https://www.brytesa.com/pdf/Bryte_privacy_statement.pdfSigned atDayMonthYearSignature of policyholder
