What type of claim are you reporting?
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Please select a Claim type
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Please Select
Accident
Storm of Flood Damage
Breakdown
Fire Damage
Theft
Damaged or Cracked Windscreen/Glass
Vandalism
Other
Select an Incident Type
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Please Select
Only my vehicle was involved in the accident
I hit another vehicle
Another vehicle hit me
Accident with a person or animal
Accident with a cyclist or motorcyclist
Accident changing lanes
Accident at a junction
Accident at a Roundabout
Accident on a Motorway
Accident involving two or more other vehicles
Head on collision
Overtaking accident
I don’t know how the accident happened
Other
Select accident type
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I hit another vehicle from behind
I pulled out from a side road
I turned in front of another vehicle
I made a U-turn
I moved from being parked
I hit a parked vehicle
I reversed into another vehicle
My vehicle’s door hit another vehicle
Other
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I hit another vehicle from behind
I pulled out from a side road
I turned in front of another vehicle
I made a U-turn
I moved from being parked
I hit a parked vehicle
I reversed into another vehicle
My vehicle’s door hit another vehicle
Other
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Another vehicle hit me from behind
Another vehicle pulled out from a side road
Another vehicle turned in front of me
Another vehicle made a U-turn
Another vehicle moved from being parked
Another vehicle hit my parked vehicle
Another vehicle reversed into me
Another vehicle’s door hit my vehicle
Other
Your Information
Your Name
*
First Name
Last Name
Your Address
Street Address
Street Address Line 2
City
County
Post Code
Your Email Address
Best Contact Number
*
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Your Policy Number
Your Vehicle Registration
*
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Incident Details
Incident Date/Time
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-
Day
-
Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Who do you believe is at fault?
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Me
Someone Else
Unsure
Please give a brief description of the incident
Details of damage to Your vehicle
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Were any other people or vehicles involved?
*
Yes
No
How Many Header
How many?
Please Select
1
2
3
More
TP1
Person/Vehicle No 1
Their Name
First Name
Last Name
Contact Number
Vehicle Registration
(If appropriate)
TP2
Person/Vehicle 2
Their Name
First Name
Last Name
Contact Number
Vehicle Registration
(If appropriate)
TP3
Person/Vehicle 3
Their Name
First Name
Last Name
Contact Number
Vehicle Registration
(If appropriate)
Final Details
Final Details
Was anybody injured?
No
Yes
Current location of your vehicle?
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