Motor Claims

1. Company Name (required)

2. Address (required)

3. Postcode (required)

4. Are you VAT registered? (required)
YesNo

5. Contact Name (required)

6. Contact Email (required)

7. Contact Tel No (required)

8. Vehicle Registration Number (Own) (required)

9. Driver Name (required)

10. Driver Date of Birth (required)

11. Date UK driving test passed (required)

12. Was the vehicle being driven with insured's permission? (required)
YesNo

13. Was the driver an employee of the insured? (required)
YesNo

14. Please provide a full description of the incident and details of the damage to your vehicle (required)

15. Who do you consider to be at fault for this incident and why? (required)

16. Witness 1 (name, address and telephone number)

17. Name of Third Party

18. Third Party Phone Number

19. Third Party Address

20. Third Party Insurers name

21. Third Party Policy number

22. Third Party Registration Number

23. Upload any related files (optional)

describe uploaded files

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