New Claim Form

Before you submit your claim, please make sure you have all the required documents ready. This will help us process your claim faster and avoid delays.

Documents You Must Submit:

Affidavit – Must be signed and stamped by the police. (You can download a blank affidavit here)
ID Document – A clear and readable copy of your ID.

Other Supporting Documentation – A proof of payment, receipt, bank proof, or payment confirmation, or any other supporting documentation.

If you are represented by a legal advisor or attorney, please include a cover letter on their official letterhead.

Please complete the form as detailed and complete as possible.

Download Affidavit

Your Details

Contact Details

Your contact details are needed so we can communicate with you about your claim. Please provide an email address or a postal address. If you do not have an email, a postal address is required.

Claim Information & Supporting Documents (Max 10 Documents)

Supported formats: JPEG | PNG | PDF

Affidavit

ID Document

I voluntarily consent to provide my personal information for this LPFF claim.

In terms of the Protection of Personal Information Act (POPIA), I understand and agree that:

My data will be stored on a secure system.
My data will be used exclusively to process, evaluate, and finalise this claim.
My data will not be shared with unauthorised third parties or used for marketing.
I have the right to request access to or deletion of my data at any time.