Damage Claim

1
Type of Damage Claim?* This field is required.Main vehicle part damaged
Please Select
Please Select
Window - Windscreen
Window - Other
Body - Dent
Bumper
Other
2
Your Name:* This field is required.
3
Phone Number* This field is required.We will call to confirm information
Area Code
Phone Number
4
E-mail* This field is required.We will email the progress of your claim
5
Have you claimed from us before?* This field is required.
Yes
No
6
What date did the incident occur?* This field is required.
Date
Month
Day
Year
7
Where did the incident occur?* This field is required.Write the Suburb/ Street/ Brief description
8
Your physical address?* This field is required.Assist with logistical planning.
9
Estimate Cost of the Damages* This field is required.Kindly attach one quote of your own
10
Kindly Confirm the following documents* This field is required.Kindly provide consent on the following documents
Certified copy of your ID
Certified copy of your Valid Driver License
Police Report / Case Number / Sworn affidavit
License of the Vehicle confirm its roadworthy
Photos of the damages
11
Brief Description of the incidentSpecific details
Should be Empty: