Online Business Interruption Claim Form

How To Fill In This Claim Form

Please fill in this form to tell the Mutual about a claim. The form needs to be completed and signed by the Member named in the Schedule or, if the Member is a company or a partnership, by one of the directors or partners. Please fill in all relevant sections as fully as possible and attach additional pages if necessary together with copies of all documents, quotes, tax invoices and receipts to support your claim. Please contact us if you have any questions about your claim or filling in this form. Using Personal Information We may collect, use and share personal information from you, other people, businesses and organisations as part of our claims process. We will only keep personal information for as long as we need to use it. You can see how we use personal information, and the legal rights of people whose personal information we hold, in the privacy notice on our website www.theretailmutual.com/privacy-notice. If you would like us to send you a copy of our privacy notice please ask us.

Printing the form

If you wish to fill in this form by hand, just click the “Print Form” button below to print out this document. All completed forms can either be scanned and emailed to [email protected] or they can be posted to: The Retail Mutual, Claims, First Floor, Douglas House, Quarry Hill Road, Tonbridge, Kent, TN9 2RH

Print Form

Otherwise please complete the form below and click submit.

Permitted files JPG, PDF, PNG can not be larger then 10MBs per file

A) Details of Membership

B) Details of the event that led to the closure

MM slash DD slash YYYY

C) Claims for Business Interruption

Business Interruption Loss

Please fill in the dates of when your business was closed and subsequently re-opened, along with the total value of your loss. If your business has been closed on more than one occasion, then please fill in each line with the relevant dates and details of the net loss incurred for each period of closure.

Please include your takings for the dates the business was closed and the same period in the last 12-24 months. In addition please provide the 3 months' previous average daily takings before closure. We may make an allowance for saving during this period for such things as: heating, lighting, telephone, office stationery, office stationery costs and business expenses.
Attach any supporting documentation here
Max. file size: 25 MB.
Max. file size: 25 MB.
Max. file size: 25 MB.

D) Declaration

Untitled(Required)
MM slash DD slash YYYY
Fraudulent and Exaggerated Claims
It is a condition of the cover that it may be forfeited and claims rejected if any claim is found to be fraudulent, which includes being deliberately exaggerated, or if any false declaration or statement is made in support of it.
Attach any supporting documentation here
Max. file size: 10 MB.
Max. file size: 10 MB.
Max. file size: 10 MB.
Max. file size: 10 MB.