Fill out this form to make a Dell insurance claim.

After you have filled out this form, please hand your device to an I.T Technician.


Student Name*
Year Level*
Parent Name*
Service Tag*
Is there any pre-existing damage on the laptop/notebook/tablet
If Yes, please describe
Describe the damage and how it occured
When did loss or damage occur
Where did the incident occur?
Who discovered the damage?
Do you or your parents have Home Contents or Personal Effects Insurance
Have you made a claim for this device in the past?
Was the matter reported to the police?
Police Report Number
Police Station
Name of Officer
Were there any signs of forced entry?
If yes, where on premises / vehicle was entry gained
Word Verification: