motor insurance claim form -

INSURED

full name

address

mobile No

Relationship to the owner of the car
owner non-owner

VEHICLE DETAILS

make

model

plate No

chassis No

color

insurance period

from

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