Please note that this form is for notification purposes only and does not constitute making an actual claim.
One of Mauritian Eagle Insurance's claim staff will contact you shortly after receiving this notification.

Fields marked with an * are compulsory.
Disclaimer
I understand that this does not constitute an actual claim, but rather a notification of an existing loss or claim, and may help expedite the claim process once I have filed. I have read and agree with the above disclaimer.
PERSONAL INFORMATION
Policy Holder Information
Name of insured*
Address
Business phone
Home phone*
E-mail *
Policy Number
Period of insurance (From - To)
DESCRIPTION OF LOSS / INCIDENT
Date - Time
Address where loss    occured/incident occured
Description of loss    /    Brief statement of    circumstances
Authority Notification
Were the Police/Fire Dept./    Coast guard called?	Yes No
If yes, Which authority