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 Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Vehicle Registration Number
*
Vehicle Make and Model
*
Date of Incident
*
-
Day
-
Month
Year
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
*
Upload a File
Drag and drop files here
Choose a file
pdf, jpg, jpeg, png
Cancel
of
Upload Evidence that your claim with your main insurer has been settled stating that you were at fault.
*
Upload a File
Drag and drop files here
Choose a file
pdf, jpg, jpeg, png
Cancel
of
Upload Certificate of main insurance policy that you have paid the excess on.
*
Upload a File
Drag and drop files here
Choose a file
pdf, jpg, jpeg, png
Cancel
of
Declaration and Consent
*
Submit
Should be Empty: