Claim Form

Adamjee, one of the insurers, is a worldwide
leader in Insurance and
Asset Management with a purpose of
Empowering people to live a better life.

Motor Claim Form

The company does not admit liability by issuance of this form.

Claimant Details

Driver Details

Vehicle Details

Accident Particulars

I agree to provide additional information to the company, if required. I solemnly declare that to the best of my knowledge and belief the foregoing particulars are true and correct in every respect and authorize you lodge a claim on my behalf against the third party (if any)

Your Experience Matters

Pleasant experience

I had a pleasant experience with them, they were quite fast in responding to my query which I really appreciate.

Priya, Sri Lanka