Motor Theft Claim

Please complete and submit the form below. Once this is done you will receive a confirmation email with your claim and we will be in touch shortly thereafter.

* Required Field

Insured

Insured First Name *
Insured Last Name *
Insured Contact *
Insured Contact E-Mail *
Insured Address (line 1)
Insured Address (line 2)
Insured Address (line 3)
Insured Tel (Work)
Insured Tel (Home)
Insured Tel (Cell)
Insured Policy No
Insured Vat No
Exact Type of Aircraft
Aircraft Reg No
Please leave this field empty.

Insured Vehicle

Make of Vehicle
Model of Vehicle
Exterior Color of Vehicle
Year of Manufacture
Registration Number
Engine No
Chassis No
Component No
Kilometres
Date of Purchase
Details of Scratches
Details of Personalization
Details of Other Features Assisting in Identification
Purchase Price (in South African Rands)
In Whose name is The Vehicle Resistered
Anti-Theft - Make
Anti-Theft - Fitted By
Anti-Theft - Date of Fitting
Details of Window Marking - Number
Details of Window Marking - By Whom

Financing Details

Type of Agreement
Account Number
Amount (in South African Rands)
In Whose Name is The Vehicle Registered

Theft Details

Date of Theft
Time of Theft
Place of Theft
Was The Vehicle Locked
Who Is No In Possession Of The Keys
Police Station Where The Theft Was Reported
Police Reference Number
What Was Stolen

Circumstances of Theft