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Claim Submission
Motor Claim
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*FullName
*Email
National ID
Gender
Male
Female
*Phone Number
Address
Date Of Birth
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Name of driver in accident
Driver is
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Owner
Employee
Relative
Friend
Owner Authorised Journey
No
Yes
Purpose vehicle was being used for
Driver was licensed to drive
No
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
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Police Report
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Drivers license copy
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3 Quotations from reputable garage
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3 images to show damage
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