FORM A

COVERING LETTER

(For Theft Insurance Only)

Enclose the below documents and send it to UB Insurance Associates, at following address:

UB Insurance Associates,

(Apps Daily Claims Division),

S 204 and 205 Suraj Plaza,

196/8, 25th cross 8th Main,

Jayanagar 3rd Block,

Bangalore 560011.Karnataka.

Contact No: 080 41258884 / 080 41258885

Note: Please send the hard copies of original documents mentioned below to UB Insurance

Associates, Bangalore for Claim processing.

List of Documents to be enclosed with this Letter: Tick ()

Original Bill on Claimant's Name.

Self-Attested Photo ID Proof of Claimant.

Police Complaint Letter.

SIM Blocking Letter or Email Copy from Service Provider.

Insurance Claim Form.

Claim Pre-Receipt Voucher - Bank Details Form.

Cancelled Cheque or Photocopy of Bank Passbook showing all Account details.

Letter of Subrogation on stamp paper along with Notary.

I hereby declared that all the above documents tick marked are attached with this letter.

Name of Claimant:

Date:

Place: Signature of Claimant