Structured claim submission with document uploads.
| Field | Type | Required |
|---|---|---|
| Policyholder Name | Text | Required |
| Policy Number | Text | Required |
| Required | ||
| Phone | Tel | Required |
| Date of Incident | Date | Required |
| Claim Type | Select | Required |
| Description of Incident | Textarea | Required |
| Supporting Documents | File | Optional |
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