The provision of my benefits is enabled by an insurance policy held by Visa International Service Association for member banks and issued to Visa International Service Association from Chubb Insurance South Africa Limited. As a Visa Cardholder of a member bank you have the right to lodge claims against the insurance policy holder by Visa International Service Association, and understand that not all events or items are automatically covered by the insurance policy and are subject to the terms, conditions, cover limits, exclusions and excess where applicable. By completing this form you have initiated the claim request process for a representative to contact you. Chubb Insurance South Africa Limited (Reg. No. 1973/008933/06) is an authorised Financial Services Provider (FSP No. 27176).