Motor Claim Form

Tell us who you are and about the type of your vehicle?

I am a workshop representative/agent registering the claim on behalf of customer I am a policy holder with a private vehicle
I am a policy holder with a commercial vehicle

Insured Details

Policy number Please enter policy number

Full Name Please enter a name

Mobile Number Please enter a mobile number

Email Please enter a email address

Vehicle Registration Number Plese enter Reg no

Claim Details

Type of Claim

Please select type of claim

Date of Loss and Time

Please select date of loss

Loss Location Pincode Please enter a pincode

Select Loss Location State

Please Select State

Loss Location Please enter loss location

Loss Description Please enter loss Description

Is Your Vehicle in Workshop

Yes No

Please Select a Option

Workshop Name Please enter Workshop Name

Contact Number (Optional) Please enter a mobile number

Contact Person (Optional)

Was Vehicle parked

Yes No

Please select one of the option

Driver Name Please Enter Driver Name

Driver License Number (Optional)

Claim

Report A Claim

Claim Process

Claim Tracker

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Motor Claim Form

Tell us who you are and about the type of your vehicle?

Insured Details

Claim Details

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