Motor Vehicle Claim Form (non theft)

For motor vehicle theft claims please complete the THEFT CLAIM FORM

Your Details

So we know who to call if we need more detail
so we can send you a copy of this form
please select branch code

Vehicle Details

please provide class code (if known)

Details of the Hirer

Incident Details

where did the incident happen?

Damage to your Vehicle

If no, please proceed to "Details of other vehicle" section

If yes, please complete the following additional questions

Damage Area Diagram

eg. D1, F1, F2

Details of other Vehicle

If no, please proceed to "Details of Other Parties" Section

If yes, please complete the following additional questions

Details of Other Parties

(e.g. pedestrians, owners of property or owners of animals involved)

If no, please proceed to "Police" section

If yes, please complete the following additional information

Police

If no, please proceed to "Witness Details" section

If yes, please complete the following additional questions

Witness Details

If no, please proceed to the "attachments & additional information" section

If yes, please complete the following additonal information

Attachments & Additional Information

Tip: You can upload multiple documents or images by using a ZIP. folder

IMPORTANT: PLEASE ONLY HIT SUBMIT ONCE - THE PAGE MAY TAKE A MINUTE TO THINK


PLEASE CHECK THAT THIS FORM HAS BEEN FULLY COMPLETED AS ANY OMISSIONS MAY DELAY YOUR CLAIM.