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Home
About Us
About Auto Claims
Privacy Policy
Complaints Procedure
Services
Replacement Vehicles
Personal Injury
Accident Repairs
Own Fault Repairs
Non Fault Accidents
Legal Assistance
Taxi Fleet
Crash Guard Membership
Brokers
Fleet Management
Latest News
Contact Us
Fast Action Claim Form
Referrer
Name
Email
Comprehensive Theft
Comprehensive Fault
Non Fault Comprehensive
Non Fault Third Party
1. Client Details
Name
Telephone
Driver Name (If Different)
Full Address
Crash Guard Member
Crash Guard Member
Yes
No
Membership Number
2. Vehicle Details
Make
Model
Registration Number
3. Insurance Details
Insurance Company Name
Policy / Claim No
Policy Expiry Date
Cover
Cover
Full Comprehensive
Third Party, Fire and Theft
Third Party Only
4. Third Party Details
Name
Telephone
Third Party Full Address
Make
Model
Registration Number
Third Party Insurance Company Name
Third Party Policy No
5. Accident Details
Incident Location
Incident Date
Incident Time
:
HH
MM
AM
PM
Please describe in full the accident circumstances:
6. Injured Parties Details
Injured Parties Name
Injured Parties Injuries
Injured Parties Full Address
Please pursue a Claim for the Following:
Please pursue a Claim for the Following
Hire
P/I
Repair
Excess
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