Crown Rentals Limited

Claim Form

Should you wish to submit your claim, you can do this online 24 hours a day using the Claim Form below.

Client Details

Name * Title First Last
Date of Birth / DD / MM YYYY
Employment Status *
Address *
Address Line 1

Address Line 2

Town/City

County

Postal Code
Telephone *
E-Mail *

Client Vehicle Details

Vehicle Owner *
Vehicle Registration *
Vehicle Make *
Vehicle Model *
Vehicle Colour *
Engine Size [CC]
Vehicle Damage *

Client Insurance Details

Insurance Company *
Policy Number *
Insurance Cover *

Third Party Details

Name Title First Last
Address
Address Line 1

Address Line 2

Town/City

County

Postal Code
Telephone
Email

Third Party Vehicle Details

Vehicle Registration *
Vehicle Make
Vehicle Model
Vehicle Colour
Vehicle Damage

Third Party Insurance Details

Insurance Company
Policy Number

Accident Details

Accident Date * / DD / MM YYYY
Accident Time * : HH MM AM/PM
Accident Location *
Accident Description *

Injury Details

Have you sustained any injuries? *
Description of injuries

Additional Details

Please provide any other details including names and contact numbers for any passengers and/or witnesses.

Declaraton

I declare that to the best of my knowledge and belief the information in this form is true and correct and I have not withheld any relevant information.

I consent to Crown Rentals Limited using the information I have provided on this form for the purpose of processing my claim; however, I understand that if I choose not to provide the required details, Crown Rentals Limited may not be able to process the claim.

All claims submitted to Crown Rentals Limited are subject to screening using a number of recognised fraud prevention databases and registers including NETFOIL. This process is designed to verify information submitted in an endeavour to prevent the handling of fraudulent claims.