Submit a claim ticket
GWtech claims administration > Claims admin > Submit a claim ticket
 

Use this form to submit claim Ticket. Required fields are marked with *

Name: *
Email: *

Category: *
Priority: *

Underwriter: *
Department:
Excess: *
Excess Status: *
Incident Date: *
Insured Peril: *
Insured Name: *
Insured Cell Number: *
Insured H/W Number: *
Insured Email address:
Insured Address: *
Insured Area: *
Other Info:
Name:
Contact Numbers:
Email Address:
Address:
Savings Value:
Invoice 1 (GWR USE):
Invoice 2 (GWR USE):

Claim Number: *
Message: *

Attachments:









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Before submitting please make sure of the following
  • All necessary information has been filled out.
  • All information is correct and error-free.
We have:
  • 54.92.163.105 recorded as your IP Address
  • recorded the time of your submission

 

 
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