Existing Policyholders

Car insurance claim notification

This form allows you to notify us of a claim on your insurance policy. Your claim request will be dealt with as quickly as possible upon receipt of all details. We will advise you what action you should take. This is normally within 48hrs of us receiving the details. All claims are subject to our assessment.

Your policy details :
Title	Mr Mrs Miss Ms Dr Sir Prof Reverend Councillor Dame Dean Judge Lady Lord
First name
Surname
Postcode	(xxxx xxx)
Your reference number
Email address
What is your mobile phone number?
What is your daytime phone number?
Claim Details :
Incident date
Area of damage
Vehicle registration
Driver of vehicle
Type of incident	Single vehicle Multiple - one or more vehicles Theft - Unrecovered Theft - Recovered Vandalism Fire Windscreen claim
Please provide a description of the incident in as much detail as possible
Condition of vehicle	Driveable Undriveable
Are there any personal injuries involved ?	Yes No

Please provide details of any third parties involved in the incident. Up to three individuals can be named :

(1) Name
(1) Address
(1) Vehicle registration
(1) Insurer & Policy number
(2) Name
(2) Address
(2) Vehicle registration
(2) Insurer & Policy number
(3) Name
(3) Address
(3) Vehicle registration
(3) Insurer & Policy number
Who do you think is responsible for the accident ?	Fault No Fault
Any other details or amendments ?

 

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