Claim Intimation - customer

Vehicle

Claim Type

Policy No.

Insured Vehicle Plate No.

plate alphabet

Sequence number

Chassis No.

Driver Mobile No.

Cause of loss/accident

Accident city

Date of loss

Accident Description

Source of Report

Police Report/NAJM Case No

Vehicle Make

Vehicle Model

Driver name

Driver Nationality

Driver National ID

Date Of Birth

Driver Gender

Email ID

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By submitting these information, you confirm data entered are correct, where claims will be rejected if any information provided are incorrect.