Motor Vehicle Windscreen Claims

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Claim Form - Motor Vehicle Windscreens Only

DD slash MM slash YYYY
Address where incident occurred(Required)
Has the windscreen been repairer/replaced?(Required)
If YES, has the repair account been paid?
If Yes, please attach a copy of the tax invoice
If NO, have you found a repairer and has the repair been quoted?
DD slash MM slash YYYY
Drop files here or
Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 16 MB.