Motor Vehicle Accident Claim Form

Passengers in insured vehicle

Details of any other property damaged

Personal injuries (other than in insured vehicle)

	Name of injured	Age	Relationship to accdeint eg. driver \ passenger	Details on injury	Name of hospital, if applicable
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Details of other vehicles involved in accident

Accident
Please note you can report minor motor accidents on the Natis online portal.

All crashes must be reported within 24 hours or the next working day.

The Natis system is only for minor damages, the following scenarios would need to be reported to South African Police Services:

If anyone is injured or if there are fatalities.

Hit and runs

Accidents involving from than 5 vehicles

Weblink - NaTis Portal
Time
Place
Speed before impact
Speed at moment of impact
Weather conditions
Visibility
Road surface
Width of road
Were the vehicle's lights on ?
Street lighting
Was any warning given by you, e.g. hooting, indicators, etc ?
Name of police station where accident was reported
SAPS case reference number
Name of policetraffic officer who recorded accident details
Was our driver tested for alcohol or drugs ?
Was the third party tested for alcohol or drugs ?
Description of accident
Sketch of accident
Please show clearly the point of impact and indicate the direction of travel by arrows Give details of any road safety signs or warning signs in vicinity of scene of accident.
Please note that after authorization of a valid claim, the repairer will pre-order the parts (if applicable) and will contact you to make arrangements to book the vehicle in on the first available Monday once the parts have arrived for commencement of repairs. Should the Car Hire option be applicable to you, a hired vehicle will be arranged for the same day that the repairer can commence repairs to your vehicle.

Date

DayMonthYear
Date
Supporting documents

Please attach copies of the following : drivers license and page 1 of drivers identity document. Any quotes or other related document can also be uploaded here.
File Upload

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Declaration

We hereby declare the foregoing particular to be true in every respect
Signature of Driver

Clear
Signature of insured

Clear
Date

MonthDayYear
Date
How we handle your personal information:

We are committed to handling your personal information in confidence.

We need to collect, use, and disclose your personal information to consider your application and to provide the insurances needed, including the required on-going servicing of your policy. We will share your personal and risk information with Insurers, claims providers and suppliers. Any information provided to us may be stored in a shared database and used by Insurers. This includes information regarding the renewal or continuation of your policy or any claim that you may submit. This information may be checked against other legal sources or databases insofar as it relates to the servicing of your policy.
Should be Empty:

Vehicle