Motor Claim

*FullName

*Email

National ID

Gender

Male

Female

*Phone Number

Address

Date Of Birth

Name of driver in accident

Driver is

Owner Authorised Journey

Yes

Purpose vehicle was being used for

Driver was licensed to drive

Yes

Name of vehicle

Make

Address where loss occured

Date of loss

Weather conditions

Full Extent of damage

Details of injuries if any

Damage to third party property

Reg Number

Time of loss

How the loss occured

Road Surface

Estimate Repair cost

Name of passengers

Name(s) of third parties

Police Report

Drivers license copy

3 Quotations from reputable garage

3 images to show damage