Initial Claims Advice Form - General Claims

For all non-windscreen claims you can call email us (Contact Us), complete the brief on-line notification form below or call us on (09)579 5794.

If immediate advice is required, please phone us on the number above.

Fields with an asterix (*) are compulsory

Name of Insured*:
Contact Name*:
Contact Details*:
(provide at least one)
Home:
Business:
Mobile:
E-mail:
Broker:
Policy Number:
(if known)
Date of Loss*:
Vehicle*:
(make and model)
Registration No.:
Driver's Name:
Cause:
Location of Vehicle:
(eg: repairer)
Estimated Cost:
Name of any Third Party:
Insurer of any Third Party:
(if known)

Additional or relevant information:

 



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