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January 1, 2020

Sustaining Our Green Legacy at Inkiito Primary School

Protecting what matters most — tailored insurance and expert advice for individuals and businesses.

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International House, along Mama Ngina Street, 5th Floor, Nairobi.

0709 159 000 info@viva-365.com

Your Name

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Date

Please, describe the event/circumstance leading to the grievance

Please provide a detailed account of occurrence (Please include names of persons involved, if any)

Has any corrective action been taken to address the grievanceYesNo

What is the proposed corrective action to address the grievance

Malpractice Details

Description of the malpractice

Where did the malpractice occur

Subject

Attach any supporting files

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Is thealleged malpractice still ongoingYesNoUnknown

Personnel /officer (s) involved in the malpractice

Name

Position

Phone Number

Whistleblowers Information (Optional)

Name

Phone Number

Email Address

First Name *

Last Name

Policy Number

Mobile Number

Type of Claim

Last Expense CoverTravel InsuranceMotor Vehicle InsuranceMedicaidAgricultural InsurancePersonal Accident CoverMedical InsurancePension PlanMotor Cycle InsuranceFire and PerilsFidelity GuaranteeAll risksPolitical Violence & TerorismEmployers LiabilityAviation InsuranceContractors all risk coverProfessional IndemnityBurglaryWork Injury Benefits Act ( WIBA)Public/Product LiabilityCorporate Medical InsuranceMarine Open CoverBonds

Date of accident

Location of accident

Circumstances of accident

Damage of Accident

Police Station Accident reported to

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