"*" indicates required fields 1Your Details2Claim Details3Alloy Wheels4Bodywork5Headlight6Suspension7Tyre8Wheel9Evidence10Declaration Please take reasonable care to provide true and accurate information and documentation. If you deliberately do not disclose a material fact, or if you withhold information, your claim may be refused and policy may be cancelled.Which vehicle are you claiming for?* Car Caravan Both Customer Name* FirstYour First and Last Name as registered to the Policy or Warranty Last Policy Number*The Unique Reference Number shown on your GAP Policy ScheduleAddress* Address Line 1The address to which your Policy or Warranty is registered Address* Address Line 2The address to which your Policy or Warranty is registered Address* CityThe address to which your Policy or Warranty is registered Address* PostcodeThe address to which your Policy or Warranty is registered Phone Number*Telephone Number and Area CodeEmail Address*A current e mail address by which we can contact you Current Vehicle Registration Number*Does your vehicle have a private plate?* Yes, my vehicle has a private plate. No, original plate. Original Vehicle Registration Number*Vehicle Make & Model*Which claim types would you like to make?* Alloy Wheels Bodywork / Paint Headlight Suspension Tyre Wheel Alignment / Rebalancing Do you have other insurance that may cover this incident?* Yes No Please provide details of the other insurance*Have you attempted to make a claim on the above insurance* How many alloy wheels are damaged?*1234Which alloy wheel was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / DriverHow is the alloy wheel damaged?*BuckledChippedCrackedScrapedPlease provide a photograph of the damage*Max. file size: 32 MB.2 - Which alloy wheel was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver2 - How is the alloy wheel damaged?*BuckledChippedCrackedScraped2 - Please provide a photograph of the damage*Max. file size: 32 MB.3 - Which alloy wheel was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver3 - How is the alloy wheel damaged?*BuckledChippedCrackedScraped3 - Please provide a photograph of the damage*Max. file size: 32 MB.4 - Which alloy wheel was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver4 - How is the alloy wheel damaged?*BuckledChippedCrackedScraped4 - Please provide a photograph of the damage*Max. file size: 32 MB.Description of Damages* How many areas of bodywork damage are there?*1234What area of the bodywork was damaged?*Front BumperQuarter - Near Side RearQuarter - Off Side RearRear BumperSill - Near SideSill - Off SideWheel Arch - Near Side FrontWheel Arch - Near Side RearWheel Arch - Off Side FrontWheel Arch - Off Side RearWing - Near Side FrontWing - Off Side FrontWhat type of damage is it?*DentedScrapedScuffedOtherPlease provide a photograph of the damage*Max. file size: 32 MB.2 - What area of the bodywork was damaged?*Front BumperQuarter - Near Side RearQuarter - Off Side RearRear BumperSill - Near SideSill - Off SideWheel Arch - Near Side FrontWheel Arch - Near Side RearWheel Arch - Off Side FrontWheel Arch - Off Side RearWing - Near Side FrontWing - Off Side Front2 - What type of damage is it?*DentedScrapedScuffedOther2 - Please provide a photograph of the damage*Max. file size: 32 MB.3 - What area of the bodywork was damaged?*Front BumperQuarter - Near Side RearQuarter - Off Side RearRear BumperSill - Near SideSill - Off SideWheel Arch - Near Side FrontWheel Arch - Near Side RearWheel Arch - Off Side FrontWheel Arch - Off Side RearWing - Near Side FrontWing - Off Side Front3 - What type of damage is it?*DentedScrapedScuffedOther3 - Please provide a photograph of the damage*Max. file size: 32 MB.4 - What area of the bodywork was damaged?*Front BumperQuarter - Near Side RearQuarter - Off Side RearRear BumperSill - Near SideSill - Off SideWheel Arch - Near Side FrontWheel Arch - Near Side RearWheel Arch - Off Side FrontWheel Arch - Off Side RearWing - Near Side FrontWing - Off Side Front4 - What type of damage is it?*DentedScrapedScuffedOther4 - Please provide a photograph of the damage*Max. file size: 32 MB.Description of Damages* Which headlight was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverBothPlease provide a photograph of damage to the Front Nearside / Left / Passenger headlight*Max. file size: 32 MB.Please provide a photograph of damage to the Front Offside / Right / Driver headlight*Max. file size: 32 MB.Description of Damages* Which suspension was damaged?*Front SuspensionRear SuspensionBothWhich area of the front suspension was damaged?*Anti Roll BarAnti Roll Bar LinksAnti Roll Bar MountsBall JointFront SpringFront SuspensionFront Suspension ArmShock AbsorberStrut AssemblyStrut Top BearingDrop LinksAxle MountingsHub AssemblyHub BearingPlease provide a photograph of the damage to the front suspension*Max. file size: 32 MB.Which area of the rear suspension was damaged?*Anti Roll BarAnti Roll Bar LinksAnti Roll Bar MountsRear ArmRear Crossmember/Sub FrameRear Crossmember/Sub Frame MountingsRear SuspensionRoad SpringHub AssemblyHub BearingSuspension Sub Frame/CrossmemberPlease provide a photograph of the damage to the rear suspension*Max. file size: 32 MB.Description of Damages* How many tyres are damaged?*1234Which tyre was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / DriverHow is the tyre damaged?*BulgeCutDamagedPunctureSplitPlease provide a photograph of the tyre damage*Max. file size: 32 MB.2 - Which tyre was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver2 - How is the tyre damaged?*BulgeCutDamagedPunctureSplit2 - Please provide a photograph of the tyre damage*Max. file size: 32 MB.3 - Which tyre was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver3 - How is the tyre damaged?*BulgeCutDamagedPunctureSplit3 - Please provide a photograph of the tyre damage*Max. file size: 32 MB.4 - Which tyre was damaged?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver4 - How is the tyre damaged?*BulgeCutDamagedPunctureSplit4 - Please provide a photograph of the tyre damage*Max. file size: 32 MB.Description of Damages* How many areas required wheel realignment / rebalancing?*1234Which area is affected?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / DriverWhat service is required?*Wheel AlignmentRebalancingPlease provide a photograph of the issue*Max. file size: 32 MB.2 - Which area is affected?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver2 - What service is required?*Wheel AlignmentRebalancing2 - Please provide a photograph of the issue*Max. file size: 32 MB.3 - Which area is affected?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver3 - What service is required?*Wheel AlignmentRebalancing3 - Please provide a photograph of the issue*Max. file size: 32 MB.4 - Which area is affected?*Front Nearside / Left / PassengerFront Offside / Right / DriverRear Nearside / Left / PassengerRear Offside / Right / Driver4 - What service is required?*Wheel AlignmentRebalancing4 - Please provide a photograph of the issue*Max. file size: 32 MB.Description of Issues* Have you reported the incident to the local council?* Yes No If no, please be aware that we may not be able to process your claim until your incident has been reported.Local Council Reference Number*Please provide evidence the incident has been reported to your Local Council*Max. file size: 32 MB.Please provide a photograph of the pothole*Max. file size: 32 MB.Please provide a copy of your repair invoice*Must be itemised to reflect the reported damageMax. file size: 32 MB.Please provide a receipt/proof of payment*An itemised invoice inc. VATMax. file size: 32 MB.Please provide a copy of your Motor Insurance Schedule*An itemised invoice inc. VATMax. file size: 32 MB. 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 declare that all information I have provided is truthful and to the best of my knowledge, and that no material information has been intentionally withheld. I declare that all property mentioned in this claim does belong to me and no other person has any financial interest in it. Where necessary to investigate and progress my claim, I give my consent for you to seek information from other Insurers and/or organisations to check the answers I have provided and prevent fraud. I understand that if I make a claim which is false, exaggerated or fraudulent in any way, my claim will not be paid and details of the fraud will be passed to the appropriate authorities for further investigation and potential prosecution. CAPTCHANameThis field is for validation purposes and should be left unchanged.