Caravan Claims

Claim Form - Caravan

DD slash MM slash YYYY
Modification and/or Accessories
Type of damage sustained(Required)
Address where incident occurred
Driver's Name
DD slash MM slash YYYY
DD slash MM slash YYYY
Have you ever lost your licence?(Required)
Have you ever had any traffic offences, fines or infringements?(Required)
Have you ever had any prior accidents and/or claims?(Required)
Did the police attend the accident scene(Required)
If the police did not attend the scene was the incident reported?:(Required)
Were any liquor/drugs, prescriptive or non-prescriptive medication consumed 12 hours prior to the accident?(Required)
Description of Items Damaged, Lost or Stolen(Required)
Witness Details - Name
Third Party Details - Name
DD slash MM slash YYYY
Drop files here or
Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 16 MB.