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Claims Form

About you

Important information

Following submission of this form, we will need to contact you to complete the registration of your claim.

Was anyone injured in this incident?
Was anyone injured in this incident?
Please complete this field before proceeding.

Does the incident involve a Third Party or was anyone injured? These incidents require a little more of our attention, so please call us on 0300 037 37 37.

Does your claim involve only windscreen damage?
Does your claim involve only windscreen damage?
Please complete this field before proceeding.

Are your windscreen or windows damaged only? Please call Glassline on 0300 037 9944 or visit https://www.autoglass.co.uk/ to arrange for a mobile repairer to come to you. You will need to tell the repairer that you are a Motability customer and show your Certificate of Motor Insurance.

My details

Please complete this field before proceeding.
If you're not the Hirer of the Motability vehicle, please confirm your relationship with them.
Please complete this field before proceeding.
Please complete this field before proceeding.
This field does not accept special characters e.g. !£$
Please complete this field before proceeding.
This field does not accept special characters e.g. !£$
Please complete this field before proceeding.
Please only use numbers to complete this field.
Please enter a date not in the future.
The date you have entered appears to be incorrect.
Please input as DD MM YYYY format.
Please only use numbers to complete this field.
Please complete this field before proceeding.
This field does not accept special characters e.g. !£$
We'll use this number to contact you if there are any problems with your request.
Please only use numbers to complete this field.
This field does not accept special characters e.g. !£$
We will use this to confirm receipt of your Incident details.
Please complete this field before proceeding.
The postcode provided is invalid.
Please find your address or add it manually.
Your postcode couldn't be found, please try again or enter your address manually.
Please complete this field before proceeding.
Please complete this field before proceeding.
Make sure your answer doesn’t include any numbers and/or special characters.
Please complete this field before proceeding.
We can only accept UK postcodes.
This field does not accept special characters e.g. !£$
You can find this on your policy schedule or certificate of insurance, starting with “RMO”.