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    Motor Fire/Theft Report Form

    IMPORTANT NOTES - Please read these notes before completing this form

    Our aim is to provide you with a fast and fair claims service. To help us to help you would you please:

    1. Fully complete ALL relevant parts.
    2. If a question does not apply write “not applicable”. Crossing out or not answering a question will cause delay.
    3. Ensure that the police and/or fire department have a record of the loss.
    4. Pass all letters from other parties to us. We will deal with them as necessary.

    ASSESSMENT

    1. To help us evaluate this claim we may ask one of our claims inspectors or a loss adjuster to call upon you to discuss the loss.
      If this is necessary you will be advised and they will contact you direct to make an appointment.
    2. Insurers exchange information with each other to prevent fraudulent claims.

    DOCUMENTATION

    If the vehicle is still missing or considered a total loss please attach the following to assist valuation

    a)
    purchase receipt
    b)
    copy finance/lease agreement (if applicable)
    C)
    service/repair accounts
    d)
    vehicle photographs

    WAITING PERIOD

    If the vehicle is subject to theft and still missing then we will usually wait for a minimum of FOUR weeks for the vehicle to be recovered. However do not wait till the end of this period before reporting the loss. Tell us immediately so that we can commence our enquires and be in a position to consider the claim at the end of the waiting period.

    REPAIR PROCEDURES

    lf the vehicle is recovered and you are able to drive it safely then please obtain an estimate for repair and send it to us as soon as possible. If your vehicle is not driveable please telephone us immediately for further instructions.

    WHAT IS NOT COVERED

    You may have to meet various expenses which are not covered by your policy. The most common are travelling costs, loss of earnings and the hire of another vehicle whilst yours is missing or being repaired.
    Accessories or special parts may not be covered, unless previously advised to us.

    MOTOR VEHICLE LOSS PARTICULARS OF CLAIM

    Insured:
    Insured vehicle:
    If vehicle recovered in damaged condition state:
    Circumstances:
    When and where was vehicle last seen?
    When was loss or damage discovered?
    I hereby certify that the above statements and the information given are true to the best of my knowledge and belief
    I further declare that to my knowledge no person other than myself has any interest in the lost or damaged property by bill of sale or as owner, mortgagee, trustee or otherwise, except as stated above.