motor insurance claim form -

INSURED&DRIVER DETAILS
INSURANCE POLICY
LOSS DETAILS
Documents Required

INSURED

full name

address

mobile No

Email

Relationship to the owner of the car

owner non-owner

VEHICLE DETAILS

make

model

plate No

chassis No

color

insurance period

from

to

insurance policy NO

Does the car have insurance from another company?

yes no

If the answer is yes, attach a copy of the insurance certificate

Choose a file

Max. size: 100.0 MB

DETAILS

Date of the accident

time

location

The driver's name at the time of the accident

age

address

Documents

polic report

Choose a file

Max. size: 100.0 MB

copy of insured's driving license

Choose a file

Max. size: 100.0 MB

copy of updated registration card

Choose a file

Max. size: 100.0 MB

copy of driver's driving license

Choose a file

Max. size: 100.0 MB

scene of accident photographs

Choose a file

Max. size: 100.0 MB

copy of driver's driving license

Choose a file

Max. size: 100.0 MB