Please fill in all the fields on this form to complete your initial claim notification under the UNIRISC Insurance Program.

Please download the Claim Form (in your preferred format using the buttons below), and complete. You must upload this form as part of your submission in order to proceed.

You will be unable to continue without providing a completed claim form.

Please check your spam email folder if you have not received a response from us within 1-2 business days.

Please choose up to 20 documents to support the claim (Total maximum file size 10MB).

Please note that you must include your Claim Form in order to proceed with your claim submission. You can use the Claim Form provided at the top of this page, or provide your own Claim Form. If you provide your own Claim Form, the file must be named either ClaimForm.pdf or ClaimForm.xls.