Client details  

Name:    Greg Williams Policy reference:    1  
Address:     102 2 Street, Northbridge 
Phone number:  3

Description of damage

Date of incident:    Sunday, 17th June  
Cause of incident:    the house was damaged during a 4
Items client is claiming for:  
     - a pair of child’s 5 
     - a new 6  
     - a torn 7 
     - repairs to the door of the 8

Builder dealing with damage  

Full name:     Steven 9  
Client to send in photographs of damaged 10 before building work starts