Following submission of this form, we will need to contact you to complete the registration of your claim.
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.
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.
Maximum 100 characters
If this person has had any accidents or convictions within the last 5 years we will require full details when we contact you to discuss this claim.
Maximum 150 characters
Maximum 500 characters
Please provide their details, including whether they were taken away by ambulance.
Please provide details of the drivers, passengers or owners of any other vehicles or property involved in the incident.
Maximum 250 characters
Please only provide details of independent witnesses (this does not include any passengers in the Motability vehicle).
(Tick all that apply)
You can upload an image relating to the incident (Optional).
The total size of the image must be under 5mb.
If the incident was the fault of another party, then we will aim to recover your uninsured losses from the person who caused the incident. These will include your policy excess, compensation for injury or out of pocket expenses. We will discuss this option further with you when we make contact.
In order to prevent and detect fraud we may at anytime:
Share information about you with other organisations and public bodies including the police. Check and/or file details with fraud prevention agencies and databases and if you give us false or inaccurate information and we suspect fraud, we will record this.
We can supply information or request further details of the database we access or contribute to.
Once we've processed your claim we'll be in touch to discuss next steps and get you booked in for repair if needed. Please make sure you've added contact details before you submit this form.
We will be in touch shortly to discuss the next steps with you.
If you have provided your email address, you will receive a confirmation email within 24 hours.