Litelok Bicycle Theft Form


Fields marked with an * are required

ABOUT YOU

CLAIM DETAILS

CIRCUMSTANCES

THEFT DETAILS

Were there any witnesses to the theft?*

YesNo

POLICE DETAILS

Did the police attend the scene?

YesNo

Was the incident reported to the police immediately?

YesNo

SECURITY

Please confirm you used the litelok which you purchased alongside your theft protection purchase to secure your bicycle

Yes

ADDITIONAL INFORMATION

Is the stolen bicycle also covered under a different insurance policy?*

YesNo

Have you made any bicycle or cycling related claims in the past three years?*

YesNo

DECLARATION

I declare that the information contained in this form is true to the best of my knowledge and I have not withheld any information connected with this claim. I accept that if I exaggerate any part of this claim, or make any false declaration or statement, I shall not be entitled to receive any benefit under this policy in respect of this claim. Furthermore, I accept that any such action on my part may render me liable to prosecution. I further agree to provide any further information or documentation as may be reasonably required. I understand that you may seek information from other insurers to check answers that I have provided. By returning this form electrically via the Yellow Jersey Cycle Insurance website in the absence of a signature constitutes acceptance of the declaration

IMPORTANT NOTICE: Insurers and their agents share information with each other to prevent fraudulent claims and for underwriting purposes via the Claims Underwriting Exchange register operated by Insurance Datatype Services Ltd. A list of participants is available upon request. The information you supply on this form, together with the information you have supplied on your insurance and any other information related to the claim, will be supplied to participants.


Please tick the box to show you have read and agreed to the above declaration

YES