Stolen motor vehicle claim

Stolen Vehicle Questionnaire

Vehicle Registration Number or VI

Any vehicle accessories/modifications? If Yes, please list

Did the vehicle have any mechanic issues whatsoever?

Yes

If yes, please describe

How many sets of keys were there for the vehicle?

Where were the keys held and by whom at the time of the theft

Where are all the vehicle’s keys now?

Who was the last person to use the vehicle?

Where was the exact location of the vehicle when it was stolen?

Were the doors locked and windows closed?

Yes

Police File Number and Police Station reported to

Has this vehicle ever been offered for sale by or on behalf of any person insured by this policy?

Yes

If yes, when?

Please give details of your movements/activities 24 hours prior to the vehicle loss

Title

First

Last

Mobile

Work Phone

Role

Date / Time of incident

Name

Signature

Sign Here

Date

Address

24/7 Dedicated Claims Support

We offer round-the-clock claims assistance. If you need to report a claim at any time, please call 0800 CLAIM247 to speak directly with a member of our team for immediate support.

Talk to our claims handler

Mike Langridge

Claims Manager

022 017 5800 [email protected]

Click here

2/1 Redmond Street, Ponsonby,
Auckland 1011, New Zealand

Clarity Insurance Brokers is an Authorised Body of Insurance Advisernet New Zealand
Ltd, FAP No. FSP26221 Authorised Body No (FSP1001710)