Tyre Insurance

"*" indicates required fields

1Your Details

2Vehicle Details

3Your Repair

4Declaration

Are you a Repairer or Dealer?*

I am a repairer/dealer

No, I am a customer

Policy Number

The Unique Reference Number shown on your Policy Schedule

Policyholder Name*

First

Your First and Last Name as registered to the Policy or Warranty

Last

Address*

Address Line 1

The address to which your Policy or Warranty is registered

Address*

Address Line 2

The address to which your Policy or Warranty is registered

Address*

City

The address to which your Policy or Warranty is registered

Address*

Postcode

The address to which your Policy or Warranty is registered

Phone Number*

Telephone Number and Area Code

Email Address

A current e mail address by which we can contact you

Repairer Name

The name of the Firm carrying out the repairs to your vehicle

Repairer Telephone Number

Telephone Number and Area Code

Repairer Email Address

A current e mail address by which we can contact the repairer

Does the vehicle have a private registration number?

Yes

Vehicle 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.

Original Vehicle Registration Number

The VRM at time of first registration

Make

The vehicle Make e.g. Volkswagen

Model

The vehicle Model e.g. Golf

Current Mileage*

The mileage at time of repair

How many tyres are damaged?

Cost Per Item*

The total cost including VAT

What tyre is damaged*

Tyre Type

Cause of Failure

Date of Incident*

DD slash MM slash YYYY

Date Fault Noticed*

The date you very first noticed the fault

DD slash MM slash YYYY

Tread Depth (Across Damaged Tyre)

Please measure tread depth using an appropriate tool eg ruler or digital / analogue tyre gauge

Tyre Size*

Please upload a photo showing the damage*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 16 MB, Max. files: 8.

Please upload a photo showing the tread depths*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 16 MB, Max. files: 8.

Second Tyre

What tyre is damaged*

Tyre Type

Cause of Failure

Date of Incident*

DD slash MM slash YYYY

Date Fault Noticed*

The date you very first noticed the fault

DD slash MM slash YYYY

Tread Depth (Across Damaged Tyre)

Please measure tread depth using an appropriate tool eg ruler or digital / analogue tyre gauge

Tyre Size*

Please upload a photo showing the damage*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 16 MB, Max. files: 8.

Please upload a photo showing the tread depths*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 16 MB, Max. files: 8.

Third Tyre

What tyre is damaged*

Tyre Type

Cause of Failure

Date of Incident*

DD slash MM slash YYYY

Date Fault Noticed*

The date you very first noticed the fault

DD slash MM slash YYYY

Tread Depth (Across Damaged Tyre)

Please measure tread depth using an appropriate tool eg ruler or digital / analogue tyre gauge

Tyre Size*

Please upload a photo showing the damage*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 16 MB, Max. files: 8.

Please upload a photo showing the tread depths*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 16 MB, Max. files: 8.

Fourth Tyre

What tyre is damaged*

Tyre Type

Cause of Failure

Date of Incident*

DD slash MM slash YYYY

Date Fault Noticed*

The date you very first noticed the fault

DD slash MM slash YYYY

Tread Depth (Across Damaged Tyre)

Please measure tread depth using an appropriate tool eg ruler or digital / analogue tyre gauge

Tyre Size*

Please upload a photo showing the damage*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 16 MB, Max. files: 8.

Please upload a photo showing the tread depths*

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 16 MB, Max. files: 8.

Please 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

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 here.

GDPR*

I consent to have this website store my submitted information so they can respond to my inquiry.

I have read and agree to the Terms and Conditions and Privacy Policy.

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Phone

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

Need some help?

We understand the importance of time, and we would never want to keep your waiting in a phone queue!

General Enquiry

Contact our customer services team via the contact us page

Sales Team

You can contact our sales team via the contact us page

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Find answers to some of the most frequently asked questions here.

Help & FAQ