GAP Insurance

Before completing the form, please note that you will need to supply copies of the following documentation.

Sales Invoice (not vehicle order form)
GAP Insurance Policy Schedule
Motor Insurers Policy Schedule (showing comprehensive coverage & all named drivers)
V5 logbook
Any letters/emails from motor insurers confirming settlement figure.
Police correspondence (if applicable)

Finance agreement (If applicable)
Finance early settlement figure(If applicable)
Third party details (If applicable)

Private Plate?*

Yes, my vehicle has a private plate.

No, original plate

Please provide a copy of your V5*

Max. file size: 32 MB.

Was someone driving the vehicle at the time of the incident?*

Yes

No

Name the person driving the vehicle*

Name the last person to use the vehicle*

Do you have any images, CCTV, or dashcam footage?*

Yes

No

Please provide images, CCTV, or dashcam footage*

Max. file size: 32 MB.

Please provide vehicle Proof of Purchase - Invoice*

Max. file size: 32 MB.

Who is the Main Driver on the policy?*

First Last

Please provide a copy of your schedule showing Comprehensive Cover and all named drivers*

Max. file size: 32 MB.

We would advise to not accept the motor insurer offer until we have checked that it is fair. Please contact your motor insurance and give your permission for us to speak to them on your behalf.

Have you received an offer from your Insurer*

Yes

No

How much has your insurer offered?*

Do you have to pay an excess for this incident?*

Yes

No

Please provide details of any claims in the last 3 years*

Finance Details

Please provide a copy of the finance agreement*

Max. file size: 32 MB.

Please provide a copy of the finance settlement*

Max. file size: 32 MB.

Third Party Details

Police Details

Have the police been notified*

Yes

No

Date of report*

Were you breathalysed*

Yes

No

What was the result?*

Additional Information

Please supply any additional information that could support your claim

Please supply any additional documentation that could support your claim

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 16 MB, Max. files: 12.

Is there any other information you wish to make us aware of?

Please be aware that a fraudulent or exaggerated claim may result in a complete loss of any entitlement under the policy.
Please note; Our Privacy Policy can be found here.

Declaration*

I hereby certify that I am the policy holder and all the information given in this form is truthful, accurate and complete.

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Name

This field is for validation purposes and should be left unchanged.

Finance Details

Third Party Details

Police Details

Additional Information

Need some help?

General Enquiry

Sales Team

Still have some questions?