How should this form be completed?

This form can be completed using your computer or internet enabled device. 

Questions marked with an asterisk (*) must be completed.

The form asks a number of questions that allow KBIS to assess your claim accurately. Please make sure that you work through the form from beginning to end answering all questions in order. 

You should contact KBIS if you:

- are having difficulties completing this form,

or

- have questions about how you should complete this form,

or

- are not sure whether this is the correct form to complete. 

You can contact KBIS by:

- calling 0345 230 2323 and choosing to speak to the Liability team.

or

- by sending an email to liability@kbis.co.uk

Important Information about this claim

This form should be completed by Policyholders who intend to submit a Personal Accident claim to KBIS.

You must take care when answering the questions on this form. KBIS’ claim assessor will use the information provided within this form to decide whether a claim should be accepted. If you do not understand the questions or the nature of the information required please contact KBIS. Failure to provide information or the provision of incomplete or inaccurate information may affect this claim.

There are conditions, limitations and excesses within the terms and conditions which may prevent KBIS paying for everything you claim.

What happens after I have completed this form?

Once you have submitted your claim form KBIS will process the claim and contact you if they require further information. The claims team aim to deal with the claim within five days of submission. 

If you have any queries you can contact KBIS directly. The telephone number to call is 0345 230 2323, alternatively, you can send an email to liability@kbis.co.uk.

Please note that the completion of this proposal form does not confirm that the claim will be paid. Your claim will be reviewed by the claims team at KBIS and, if necessary, the Underwriter. 

Policyholder's Details

The Policyholder is the person who is completing this form and making the claim. 

Dates of incapacity you are claiming for:

I declare that all the statements containted within this form are correct to the best of my knowledge.

I understand that if I have witheld information or misrepresented the facts upon which I have based this claim that my claim may not be paid and that the Insurer may void my policy.

I give permission for KBIS and/or the Insurer to access my medical records.

I understand that KBIS and/or the Insurer may appoint their own medical expert to assess this claim, I agree to cooperate with their medical representatives if necessary.