About this form

You have a statutory duty to make a fair presentation of risk to your insurers. The need for accuracy and honesty in presentation of facts cannot be overstated, To learn more about this duty see Presenting the Facts If you do not have all the information immediately to hand, please complete as much of the information as possible.

First name



Business Name

Risk Address

Phone Number

Email Address

Tell us what Happened?

When It Happened?

Hour: Date: / /

Estimated Cost To Repair

Reported to Police?

Is any Remedial/Repair or any other action required?

Confirm Name

Position In Business


Declaration By Clicking “Send” you agree to be contacted by an FCA Authorised Advisor and confirm that you have read & agree with our Terms & Conditions and Privacy Policy. The Business Insurance Bureau is authorised and regulated by the Financial Conduct Authority (FCA) and our registration number is 307026. We are authorised to conduct General Insurance and this can be verified by contacting the Financial Conduct Authority (FCA) on 0845-606-1234 or www.fca.gov.uk/register.


Alterations and changes to policy’s are not instantly active, nor should be considered acted upon until the business has had the opportunity to contact the insurers regarding your policy to make them aware of the facts.

Today’s Date:
/ /