Claim Form

Submit your claims Below:

 

Clients details

Lease/Rental Co Details

Customer questions

First name :
Sur name :
Email :
Contact No :
Mobile :
Address :
Postal code :

Customer questions

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
a) Is the damage clear in the images? Yes No
b) Is the severity of the damage visible? Yes No
c) Are the images date and time stamped? Yes No
d) Is there an image of the odometer indicating the mileage at the time? Yes No
e) Is there an image of the number plate? Yes No
Yes No
Yes No
Yes No
Yes No