SECTION 1

Questions 1-10: Corton Insurance claim form

Questions 1-40

Follow the instructions for each section and enter the correct responses.

PART 1 Questions 1-10

Complete the form below.

Write ONE WORD AND/OR A NUMBER for each answer.

Corton Insurance
New claim form

Contact Details

Customer name: Andrew Smith

Policy number: 1

Email address: asmith@fastmail.com

Date of birth: 2 1972

Previous claims in last 3 years: stolen 3 (last year)

New claim: laptop

Where purchased: 4

Approximate value: 5£

Description of damage: the laptop's 6 does not work

Item is for: 7 use

Description of accident: The client was on a 8 when the accident happened.

The laptop was on a 9 and a box fell on it.

Action to be taken: Client to obtain a 10 about the damage from a dealer