Your DetailsBefore completing the form, please ensure you have read your documentation fully. We recommend you have the documentation to hand to help you complete the form. To complete the form you will require: Policy / Warranty Documentation Your vehicle details including current mileage Are you a lloyds customer or dealer ?* Yes No Claiming For*Scratch & DentAlloyBothDate Fault Noticed*The date you very first noticed the fault Date Format: DD slash MM slash YYYY Policy NumberThe Unique Reference Number shown on your Policy ScheduleCustomer Name*Your First and Last Name as registered to the Policy or Warranty First Last Address*The address to which your Policy or Warranty is registered Street Address Address Line 2 City Region Postcode Telephone Number*Telephone Number and Area CodeEmail Address*A current e mail address by which we can contact you Where did you purchase your policy?Your RepairVehicle Registration Number*If your vehicle has a private plate, please enter that and the original vehicle registration as we require both to process your claim.Private Plate? Yes, my vehicle has a private plate. Original Vehicle Registration NumberThe VRM at time of first registrationMakeThe vehicle Make e.g. VolkswagenModelThe vehicle Model e.g. GolfLocation of Scratch & Dent*Front Driver SideFront Passenger SideFront BumperRear Driver SideRear Passenger SideRear BumperRoofBonnetBootMore Than One Area or OtherLocations of Damaged*Location of Damaged Alloy*Front Driver SideFront Passenger SideRear Driver SideRear Passenger SideMore than oneWhich Alloys are Damaged?*Location of Damage*BumperDoorWingWing MirrorDoor HandelHow Did The Damage Occur*Please list any additional circumstances which you wish us to consider when processing your claim. Dealer or Repairer. Please attach an estimate including faultPhotos of The Damaged* Drop files here or Accepted file types: jpg, gif, png. Our file upload accepts jpg, gif, png files. Individual file size is limited to 16mb. Please provide a close-up photo of the damaged area, a distant photo of the damaged area, and a photo of the damaged area with a straight edge measurement (such as a ruler.)DeclarationPlease check all your answers carefully before submitting your claim.Is there any other information you wish to make us aware of?Declaration* I hereby certify that I am the policy holder and all the information given in this form is truthful, accurate and complete. Dated Date Format: DD slash MM slash YYYY 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 on the MB&G Website.CAPTCHANameThis field is for validation purposes and should be left unchanged.
