Notifying Us of Your Claim

Complete and submit the form below no later than 48 hours after the date of the incident.

ACCIDENT REPORT FORM - It is necessary that you obtain an independent statement from a circuit official confirming the location, date and time of the accident. This form is at the back of your policy document of can be downloaded here.

PHOTOGRAPHS - It really help us to help you if photographs are taken of the damaged car at the circuit BEFORE any work commences on the repairs.

Your Details

Policy Reference:
Name of Driver involved in accident:
Tel:
Fax:
Email:

The Event

Date of Accident:
Time of Accident:
Circuit:
Name of corner on circuit:
Was there any damage caused to circuit?
Was the instructor in the car during the accident?
Were You / The Driver hurt?
Did You / The Driver receive medical attention?
If 'YES' please give details:
Track Conditions:
Details of how accident occurred:
Parts damaged:
Rough estimate of repair costs: £ no commas or spaces

Inspection Address

Please advise us of the current whereabouts of this vehicle in case we wish to carry out an inspection:
If you think that there is any other information that we should be aware of, please enter your details here:
 

Declaration

In submitting this electronic claim form, I/we declare that the above statement and particulars are true and complete to the best of my/our knowledge and belief and that no material facts have been withheld, misrepresented or misstated.

Name: Date: