Claim - MiX Recovery Protect

Basic Personal Information
Title*
Full Names*
Last Name*
ID Number*
Policy Number*
Insurance Company Name*
Date of Loss*
Vehicle Registration Number*
SAPS Case Number*
Contact Details
Contact Person*
Comments
Contact Number*
Upload Documents
Each file upload to not exceed 2MB.
Affidavit stating theft circumstances*
Accepted file types: pdf, jpg, gif, png, jpeg.
Insurance Claim Form*
Accepted file types: pdf, jpg, gif, png, jpeg.
Driver’s Licence*
Accepted file types: pdf, jpg, gif, png, jpeg.
SAPS Form 21 & Non-recovery Report*
Accepted file types: pdf, jpg, gif, png, jpeg.
Insurance Settlement Agreement*
Accepted file types: pdf, jpg, gif, png, jpeg.
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Email
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