Vodafone Keep Talking Insurance

Please review the information below, if correct please click the Submit button, otherwise click the Back button to change your information.

Insurance Product:

First Name:

Surname:

Date of birth:

Photo ID:

Are you the insurance account holder?

Driver’s License/Passport Identification Number:

Daytime contact no:

After hours contact no:

Email:

Customer Address:

Were you in possession of device?

Relationship to account holder:

Regular User First Name:

Regular User Surname:

Regular User date of birth:

Authorise Regular User on insurance claim?

Regular User’s Driver’s License/Passport Identification Number:

Regular User's Photo ID:

Insured Mobile Number:

Insured IMEI Number / Serial Number:

Has your device been exchanged under warranty or repair?

IMEI Paperwork:

Make / Model / Colour of insured device:

Date of Incident:

Type of Damage:

Does the device power on?

Is the display working?

Is the glass cracked or damaged?

Is the touch working?

Is the back glass damaged?

Is the rear facing camera damaged?

Are the earphones and speakers working?

Is the charging port damaged?

Liquid damage other than this incident?

Mobile Number at time of incident?

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