If your equipment is still within the manufacturer’s warranty, please contact the company that supplied your equipment. If your equipment has extended warranty provided by us and is not within the manufacturer’s warranty, please complete the online claim form below. I am a Key Worker, please prioritise my claim. During the Covid-19 outbreak MB&G would like to help by prioritising claims received from those deemed “Key Workers”. If you fit this category, please check the tick box. Proof of your status as a key worker will be required.Your DetailsIndividual and/or organisation submitting the claimName * REQUIRED FirstYour First and Last Name as registered to the Policy Last Organisation (if applicable)The organisation as registered to the PolicyAddress * REQUIRED Street AddressThe address to which your Policy is registered Address Line 2 City Region Postcode Contact Number (9am-5pm) * REQUIREDEmail * REQUIREDThe e mail address to which your Policy is registered Warranty Number * REQUIREDThe Unique Reference Number shown on your Policy ScheduleFault DetailsPlease note that if the device is less than 12 months old, then please contact your manufacturer. They will cover this period under their warranty. Date Fault Occured - must be mm/dd/yyyy format * REQUIRED Date Format: MM slash DD slash YYYY Fault Details * REQUIREDPlease provide full detailsOther WarrantiesDo you have any other warranty that may cover this incident * REQUIREDPlease select oneYesNoPlease provide the warranty company and warranty number * REQUIREDName, Address and Unique Reference NumberVAT StatusAre you VAT registered * REQUIREDPlease select oneYesNoPlease confirm your VAT number * REQUIREDUnique VAT Number as issued by HMRCDeclarationThe details you supply will be used to administer your claim and to combat fraud. The answers to the questions will be the basis of the assessment of your claim. All material facts must be disclosed. A material fact is one that is likely to influence us in the assessment or acceptance of this claim, or one that is likely to influence our consideration of cover under the terms of your policy. If you are in any doubt as to whether a fact is material, you must disclose it. I/We submit my/our claim for the amounts stated and declare that, to the best of my/our knowledge and belief, all information given on this form is true and correct, as will be my/our response to any further enquiries made by compuwarranty.Confirmation * REQUIRED Please tick the box to confirm you have read the declaration Details of ItemMake * REQUIREDManufacturer e.g. AppleModel * REQUIREDModel number and type as listed on the appliance or in the manualColourThe colour of the applianceSerial Number * REQUIREDThe Unique Model / Serial Number listed on the appliance or in the manualDate Purchased - must be dd/mm/yyyy format * REQUIREDDate the Item was purchased Date Format: DD slash MM slash YYYY Where Purchased * REQUIREDRetailer the item was purchased from and locationPurchase Price (inc. VAT) * REQUIREDThe price you paid for the itemAdditional InformationIf you have any additional information that will assist us with your claim, please include details below:CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.
