Motor Excess Claim Form

Motor Excess Claim Form

Please fill out this form to submit your motor excess insurance claim.
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 support@ams-gap.com
Policy Number*
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.Format: 00000 000000.
Email Address*
example@example.com
Vehicle Registration Number*
Vehicle Make and Model*
Date of Incident*

DayMonthYear
Date
Incident Description*
please provide a brief description of the incident
Excess Amount*
please enter the amount of excess your insurer has deducted for this incident
Upload Evidence the excess amount has been paid to your motor insurer following your claim

pdf, jpg, jpeg, png
Cancelof
Upload Evidence that your claim with your main insurer has been settled stating that you were at fault.

pdf, jpg, jpeg, png
Cancelof
Upload Certificate of main insurance policy that you have paid the excess on.

pdf, jpg, jpeg, png
Cancelof
Declaration and Consent*
Registered office: Heyford Park House, Heyford Park, Bicester, Oxfordshire OX25 5HD

Company Registered Number: 03976947

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

FCA Registered Number: 310422

AMS is committed to your privacy; to learn more please see our Privacy Policy

https://www.ams-gap.com/privacy-policy
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