AMS GAP Insurance Claim Form

GAP Insurance Claim Form

Please fill out this form accurately to register your claim and ensure all required fields are completed.
To help us provide the right support throughout your claim, please let us know if you have any personal circumstances or vulnerabilities you'd like us to be aware of.
Alternatively, you can call us on 01869 232563 or you can email us at claims@ams-gap.com
Policyholder's Details
Name*

First NameSurnameTitle
Date of Birth*

DayMonthYear
Date
Company Name (if applicable)
Are you VAT registered?
Address*

House Number / Name

Address
Town / CityCountyPost Code
Contact Telephone Number *
Email
example@example.com
Total Loss Details
Date of incident*

DayMonthYear
Date
Mileage at time of write-off (if known)
Was the vehicle stolen?
Has the incident been reported to the police?*
Crime Reference Number
Has your vehicle been declared a total loss by your motor insurance company?*
Has the motor insurer offered to repair your vehicle?*
Has the motor insurer offered to replace your vehicle?*
Has the motor insurer made you a settlement offer?*
If yes, please provide the settlement offer £
Please provide details of the incident in which your vehicle was written-off.*
Was the accident / incident caused by a third party, therefore you were not at fault?*
If yes, have they admitted liability?*
Have you made a claim against your own motor insurer or directly against the third party's motor insurer?*
If yes please provide their name, address and contact details
Is your claim being handled by a solicitor or accident management company?*
If yes, please provide their name, address and contact details
Vehicle Details
Make*
Model*
inc. engine size
Fuel Type*
Registration Number*
Number plate
If you have a Cherished Plate, please provide the original Registration Number
Number plate
Mileage at Delivery*
Date of First Registration*

DayMonthYear
Purchase Date*

DayMonthYear
Full Invoiced Purchase Price £*
must exclude dealer fitted accessories, road tax, warranty and insurance premiums
Was the vehicle purchased from a dealership?*

YesNo
Name of dealership
How did you purchase the vehicle?*
Finance Details
Finance Company
Name on Finance Agreement

First NameSurnameTitle
If different to AMS Policy Holder, please state relationship
Agreement Number
Start Date

DayMonthYear
Date
Finance Term
in months
Final Settlement Figure £
Must have been obtained at date of total loss. Please note we require this in writing from your Finance Company.
Motor Insurance Details
Your Motor Insurance Company*
Policy Number *
Claim Reference Number *
Policy Holder Name*

First NameSurnameTitle
Additional Named Drivers
Has the vehicle been comprehensively insured at all times?*
Is your Motor Insurance subject to any excess?*
If yes, please provide the amount of excess £
Does your Insurance Policy provide Replacement Cover? *
(i.e. If your car is less than one year old and you are the first and only registered owner, your insurance company will replace it with one of the same make and model)
Do you have a separate Motor Excess Insurance Policy?*
If yes, please provide level of cover £
NOTE: PLEASE ADVISE US OF ANY SETTLEMENT OFFER FROM YOUR MOTOR INSURER, A THIRD PARTY INSURER, SOLICITOR OR AN ACCIDENT MANAGEMENT COMPANY BEFORE ACCEPTANCE.
Checklist
The following documents are required to make a claim. They can be uploaded and submitted with this online claim form. Alternatively, they can be emailed or posted separately, details provided below.

We need a copy of:
- Your Vehicle Purchase Invoice,
- Your Motor Insurance Certificate and Policy,
- Your Motor Insurance Settlement Offer Letter.
If your vehicle is on finance, we'll also need a copy of:
- Your Finance Agreement,
- Your Finance Company Settlement Letter.
File Upload - you can attach the files here

pdf, jpg, jpeg, png
Cancelof
If you are unable to attach the files using your camera / drag and drop method, please email the attachments to claims@ams-gap.com, specifying your AMS Policy Number in the email.

Alternatively you can post them to us, at this address:

Claims

AMS

Heyford Park House

Heyford Park

Bicester

Oxfordshire

OX25 5HD
If you were unable to upload the files, please let us know how you will be sending them?
Declaration
I declare that all the information provided is correct and that I have not withheld any information which may affect the insurer’s decision to accept this claim.
I have read and agree with the above declaration.
Registered office: Heyford Park House, Heyford Park, Bicester, Oxfordshire OX25 5HD

Company Registered Number: 3976947

AMS Insurance Services Ltd, United Kingdom is authorised and regulated by the Financial Conduct Authority.

FCA Registered Number: 310422
Should be Empty:

GAP Insurance Claim Form

Policyholder's Details

Total Loss Details

Vehicle Details

Finance Details

Motor Insurance Details

Checklist

Declaration