Motor Claim Form

Motor Claim Form

This form is sent whenever an accident or loss is intimated. It must be completed and returned within 2 days of receipt.
All questions must be answered fully. Dashes are not sufficient. Please use BLOCK LETTERS
(where questions require a “Yes” or “No” answer, tick that which is applicable).

Premium Details
Manufacture Details
Registration Book Specifications
Hire Purchase/Lease Details
Vehicle Owner
Vehicle Modifications
For motor cycles only
P O Box/Telephone Numbers
Occupation/ Date Of Birth
Driving License