insurance/motor/claim

Subject *

Your Email *

Claim type *

Accident

Theft

Name of Insured *

Phone Number *

Address *

Place & Postal Code

State exact use of vehicle *

Private

Passenger Carrying

Commercial

Passenger Carried *

State Description of Goods *

Registration Number *

Name of the owner *

Phone Number *

Address *

Place & Postal Code

Driver Name *

Status *

Self

Relative/Friend

Employee

Was he/she driving with your permission? *

If employee, state duration of service *

Date & time of accident *

Place of accident *

Name of police station where reported *

Driver's statement of the accident *

Owner's narration explaining the damage of vehicle *

Name of repairer contact person *

Repairer phone number *

Details of other vehicle *

(Registration, owner's name and address)

Details of injury/Death occupants

(Name and address)

Details of Third Party Injury/Deaths

(Name & Address)

Date & Time of Discovery *

Name & Address of the person who descover the incident *

Name & Address of the person who was using it when vehicle was stolen if different from owner *

Details of earlier theft losses to the user/insured *

(Type of vehicle, Registration number, Date lost, Claimed amount & Date paid by insurer)

Attachments *

Registration Card

*

Driver's licence

*

Preliminary report PF 90 from police station

*

Preliminary report PF 93 from police station

*

Accident sketch map PF 115 from police station

Separate email addresses with a comma.

Accident? Relax everything is under control...

Accident? Relax everything is under control...