Report a Claim - RiskPilot

Before starting this form, please ensure that you have all the details and documents necessary to complete it.

Documents that are required:

Copy of both sides of the Driver’s Driving License
Driver's DVLA Summary

Additional documents that can also be attached include:

Camera Footage
Telematics Data
Photographs
Sketches

Client / Company Name*

Are you VAT Registered?*

Did Driver or driver last in charge of vehicle, have the Client's permission?*

Full Name of Driver, or driver last in charge of the vehicle*

FIRST NAME LAST NAME

Driver's Date of Birth*

Is Driver Employed or Agency?*

Name of Agency*

What date did the Driver pass their test for this Vehicle Class?*

Depot Driver assigned to?*

Does the Driver have any convictions?*

List Convictions*

Date

Conviction

Points/Charge

Does the Driver have any DVLA notifiable medical conditions or disabilities?*

List Conditions*

Condition

Date From

Upload copy of both sides of Driver's Licence*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 1 GB.

Upload DVLA Summary*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 1 GB.

Vehicle Registration*

Vehicle Make and Model*

Is the vehicle on lease / finance agreement?*

Please confirm what, if any, pre existing damage there is to your vehicle

What was the overall condition of your vehicle prior to the accident?*

Does the vehicle have a camera fitted?*

Upload Footage*

Drop files here or

Max. file size: 1 GB.

Is there telematics data for the vehicle?*

Upload Telematics*

Drop files here or

Max. file size: 1 GB.

Is the Report for an Accident or Theft?*

Date of Theft*

Time of Theft*

:

Police Station Reported to?*

Police Incident Reference Number*

Date Reported*

Last known location of vehicle prior to theft*

Was this in a locked area?*

Please detail point of entry and any damage*

Is there any CCTV or Ring Doorbell footage?*

Upload CCTV Footage

Drop files here or

Max. file size: 1 GB.

Has the vehicle been recovered?*

Date of Incident*

Time of Incident*

:

Location of Incident*

Speed at time of accident*

Road Speed Limit*

Weather Conditions*

Road Conditions*

Were the Emergency Services called?*

Emergency Service Location*

Incident Reference Number*

Date Emergency Reported*

Is there damage to your vehicle?*

Describe the damage done to the vehicle*

Do you wish to claim for damage to your vehicle?*

Do you have photographs of damage?*

Photos of Damage*

Drop files here or

Max. file size: 1 GB.

Is the vehicle mobile/road-worthy?*

Where is the vehicle located to arrange an inspection?*

In respect of the repairs, do you require our recommended Specialist Repairer to contact you?*

Please provide a full description of events*

Who do you consider to be at fault for this incident and why?*

Are any Third Parties involved?*

Third Party Details*

Name

Address

Telephone

Registration

Insurer Details

Are there any Witnesses?*

Witness Details*

Name

Address

Telephone

Registration

Do you have any further documents to upload, such as a sketch etc?*

File

Drop files here or

Max. file size: 1 GB.

Name of the individual completing this report*

FIRST NAME LAST NAME

Email address of the individual completing this report*

A COPY OF THIS SUBMISSION WILL BE SENT TO YOU FOR YOUR OWN RECORDS

Declaration*

I declare that to the best of my knowledge and belief the details provided in this report are true and accurate

Submission Date*

CAPTCHA

Cookie	Duration	Description
cookielawinfo-checkbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.

Report a New Claim

RiskPilot Claim Form

ABOUT US

Report a New Claim

RiskPilot Claim Form

Search