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Emergencies

This claim form is for non-emergencies only.

Insurer emergency numbers are available here:

https://www.alanboswell.com/claims/emergency-claim-numbers/

Consent(Required)

I confirm this is not an emergency situation

To log a claim you will be required to submit documents (e.g. drivers licence, proof of DVLA check, hire agreement etc)

Your details

Policy reference (if known)

This is the reference on documents in following format 0/ABCD12

Your name(Required)

First

Last

Your email(Required)

Your phone number

Company name (if applicable)

Is the company VAT registered(Required)

Yes

Claim details

Please provide as much detail as possible.

Name of hirer(Required)

Name of driver(Required)

Driver date of birth(Required)

DD slash MM slash YYYY

Date passed test(Required)

DD slash MM slash YYYY

Any medical issues declared to DVLA(Required)

Yes

Any motor convictions(Required)

Yes

Number of passengers in vehicle

Any injuries(Required)

Yes

Vehicle registration number(Required)

Damage to vehicle

Date of incident(Required)

DD slash MM slash YYYY

Vehicle location at time of incident(Required)

Enter a postcode, road name or landmark

If you have called the emergency services please provide the reference number

Does client have dash camera

Yes

Please describe the accident circumstances(Required)

Witnesses information

Were there any witnesses(Required)

Yes

Full name of witness

First

Last

Phone number of witness

Witness address

Street Address

Address Line 2 City County / State / Region ZIP / Postal Code Country

Is a third-party involved?(Required)

Yes

Third Party details

Third-party name

First

Last

Third-party email

Third-party registration number

Is third-party based in the UK?

Yes

Third-party phone number

Third-party postcode

Third-party phone number (international)

Third-party address (international)