If you have broken down or been involved in an accident, pull over and exit the vehicle on the opposite side to the traffic. Please make sure the vehicle and all passengers are safe before filling in this form. For emergency medical assistance please dial 999 in the UK or 112 in Europe
Accident: Collision with other vehicles, property or persons Breakdown: Vehicle not starting, warning lights, flat tyres, broken windows and other mechanical issues Damage: Bodywork, interior or equipment, howsoever caused Other Assistance: Help with operating the vehicle or other assistance
Please help us understand the facts about what happened so we can forward this to our insurers. It is important that you describe as much detail as possible and avoid claiming responsibility to any third parties