Hi! Ali, first of all I appreciate your work but there are some issues in your work.
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Your validations are absents. I clicked on claim button and it directly open 405 response page.So add validation and custom message.
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One more thing you can also check that, if mouse clicked on any of the input then suddenly there will be slightly change in the height of the page.
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In mobile response, your text don't have enough space to make it more readable and well structured.
I hope you understand.
Good Luck