Claim Registration Form

CLAIM REGISTRATION FORM-ORA Policy

Important announcement! Request you to drop an email at support@orapolicy.com for the large attachment from your registered email id.

FIRST NAME

(Name as per the policy)

LAST NAME

(Name as per the policy)

EMAIL ID

MOBILE NUMBER

ALTERNATE CONTACT NUMBER

(Optional)

POLICY NUMBER

IMEI NUMBER / SERIAL NUMBER

(Kindly input any one IMEI Number)

DEVICE

iPhone Android SmartPhone Laptop iPad Tablet Television SmartWatch Home-Appliance Other

NATURE OF CLAIM

Screen/Display Damage Back Glass/Panel Damage Liquid Damage MotherBoard Problem
Malfunctions Device not working Warranty Related Issue Not sure about issue
Theft/Stolen/Robbery Other Issue

DATE OF INCIDENT

CLAIM DESCRIPTION

ADDRESS

CITY

(max 30 characters a-z and A-Z)

PIN CODE

(6 digit number)

STATE

(max 30 characters a-z and A-Z)

COUNTRY

ONLY FOR CORPORATES

Nature Of Claim	Devices	No. Of SmartPhone(s)	No. Of Laptop(s)	No. Of iPad(s)
1	Damage
2	Theft
3	Malfunctions
4	Others
		(10,000 SmartPhones max)	(10,000 Laptops max)	(1000 iPads max)