Claim Intimation Feedback

Contact Person

Khondaker Fakrul Alam

Deputy General Manager

Cell : 01819­202923

E­mail: fakrul@unitedinsurance.com.bd

Feedback
Name of the Insured :* 

Policy/Certificate/Cover Note No :* 

Date of Loss : 

Place of Loss : 

Cause of Loss : 

Description of Loss : 

Nature of Loss : 

Estimated Loss, if any : 

Contact Person Name : 

Address : 

Phone No : 

Mobile No : 

Fax No : 

Email : 

Vehicle No. (If Motor Claim) :