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Make a claim

Make a Claim

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Make a Claim

To make a claim call our dedicated claims team on 01924 871111, selecting option 5 for claims.

Or alternatively, send the claim details direct to our team by completing the claim forms below.

Property Claim Form
Motor Claim Form

Property Claim Form

Details of Policy

Policy Number

Details of Policy Holder

Company Name Address 1 Address 2 Address 3 Postcode Telephone Number Contact Name Nature of Business Are you registered for Value Added Tax?

Yes No

Information about the loss/damage

When did the loss/damage occur?

Month Year Time Where did the loss/damage occur? How did the loss/damage occur? When and by whom was loss/damage discovered?

For theft or malicious damage

Were Police advised of the loss?

Yes No

Crime Reference Number Police Station By what means was access gained to the premises? Is there a burglar alarm installed at the premises?

Yes No

IF YES, was it activated by the thieves?

Yes No Not Applicable

Details of third party

Was the loss or damage caused by any third party?

Yes No

IF YES, please provide name and address of third party responsible for the loss or damage (if known)

Company Name Address 1 Address 2 Address 3 Postcode Telephone Number

Details of Claim

Wherever possible attach a detailed estimate for repair. If item(s) beyond repair, please provide original purchase and replacement invoices. If definite costs are not yet known, please state approximate cost.

Description of each item of property lost, destroyed or damaged If you are not the sole owner, please give details of your interest and that of other parties Date Item(s) purchased Cost Price Value of Salvage Amount Claimed Total Amount Claimed

Other Insurances

Is the property claimed for covered by any other policy?

Yes No

IF YES, please complete below:

Name and Address of Insurer Policy Number

Declaration

Declaration Statement

I/We hereby declare that to the best of my/our knowledge and belief all information given on this Claim Form is correct.

Today's Date Policy Holder Name

Leave this field blank:

Motor Claim Form

policy details

Policy Number Policy Holder Contact Address Post Code Phone Number Excess Cover VAT Registered

Yes No

vehicle details

Registration No Make & Model Owner Lease/HP Mileage Colour Any Modifications

driver / person in charge

Name Date of Birth Address Post Code Contact Phone No Does driver have Full Licence?

Yes No

Details of any convictions Is the driver employed by the Policy Holder?

Yes No Not Applicable

IF YES, in what capacity? IF NO, what is relationship to Policy Holder

incident details

Date Time Incident Location Description of Incident Where you at fault?

Yes No

Did the Police attend?

Yes No

Police Details Speed of Travel Number of Passengers

additional notes

Claim for damage Has an estimate been carried out?

Yes No

Area & Extent of damage

third party details

Name Address Post Code Contact Phone No Vehicle Reg Make & Model Area & Extent of damage Insurer Policy Number Are you aware if Third Party was in a Hire vehicle?

Yes No

IF YES, please state Company name No. of passengers

theft (if applicable)

Theft Location Date & Time of theft Circumstances of theft Any personal effects stolen

Yes No

Was the vehicle unattended?

Yes No

Were the doors/boot locked?

Yes No

Where were the ignition keys? Has the vehicle been recovered? (Details of location)

injury

Name of any injured parties Address Telephone Number Injury sustained

other information

Witness Name Telephone Number Address Are they independent?

Yes No

Any other information Declaration

I/We hereby declare that to the best of my/our knowledge and belief all information given on this Claim Form is correct.

Leave this field blank:

Contact Details

WTJ Insurance Brokers Ltd
Landmark House,
556 Leeds Road,
Outwood,
Wakefield,
WF1 2DX

Telephone:
01924 871111

Fax:
01924 829900

Email:
insurance@wtj.co.uk

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