Make a Claim
Please complete this online claim form with as much information as you can provide. This will enable us to process your claim quickly and with as little delay as possible.

Please complete the form honestly. Failure to give us all the information we require, or not providing accurate information, may lead to your claim being declined.
Your Details
Parent/Guardian Name *
Contact Email *
Student Name *
Claim Details
Date incident occurred *
Time incident occurred *
Screen protector fitted? *
Please tell us what you were doing when the device was damaged *
Where did this damage occur? *
How did the damage occur? Please start from the last time the device was intact and describe everything that happened in as much detail as possible up to and including when the damage occurred *
Please tell us what is wrong with the device *
Describe the damage to the device *
Describe the condition of the device prior to the incident *
Who witnessed the incident? Please include their names and contact details *
What did you do to prevent the loss or any damage occurring? *
What steps will be taken to prevent any further breakages in the future? *
Is the Insured aware of any other Insurance's (whether or not in the Insured's name) covering the loss or damage liability? If so, please give details *
Is there any other information you would like to provide in support of your claim?
Use of Personal Data
Conyers School requires your consent in order that we may process your claim. If you do not provide your consent we will be unable to process your claim.

Conyers School will share your name, contact details and device details with our insurers, repairers and/or suppliers of replacement devices for the purpose of dealing with your claim. In addition, any information you may provide when submitting your claim may be shared with other insurers and their agents to help prevent fraudulent claims. Burnett & Associates Ltd may pass your information to a claim investigator as part of the standard claim procedure whether at random or specifically selected to help in assessing your claim.
Backup your data
Once a claim is agreed, our insurers will arrange either repair or replacement of the device. Therefore it is important that the user of the device backs up their data as we cannot be held responsible for any loss of data in the event of a replacement being issued. You can find information on how to back up your device by going to
Conyers School, our insurers, service providers, agents and business partners may contact anyone who can give them information relevant to my claim. I confirm that the information I provide is true and if any of the information given by me (or anyone on my behalf) is incorrect, I agree that such inaccuracy may cause me to forfeit my rights under the policy.

Where a representative of the student is completing this form, the representative confirms they have the authority to act on behalf of the student.
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