Make a Claim Claim Form IPF CLAIM FORM Claimant's Details Type of Claimant Natural Person Corporate Person Title MrMrsMissMsDr Surname First Names National Identity Number Citizenship (State Country) Residential Address Name of Company Company Representative (Title & Name) Postal Address Cell Number Email Address Stockbroker Details Name of Stockbroker Address of Stockbroker Details of Claimed Investment Type of Investment Shares/Stocks Exchange Traded Funds (ETFs) Debt Securities Other Amount Invested Date of Investment Reason for Claim Supporting Documentation Please upload PDF, JPG, or PNG files only. Certified Copy of Identity Document (Birth Certificate / National I.D. / Passport) Letter from stockbroker in support of claim Documentation in support of claim (copy of deal note, statement etc.) Certified copy of proof of residence I certify that the information provided is to the best of my knowledge true and accurate in every respect. I fully understand that in the event of any misstatement, misrepresentation or fraud, the Investor Protection Fund will take legal action for which I will be held personally liable.
