0800 825 0081 motor@redsealclaims.com

Commercial Vehicle Theft Report Form

You will need:

– Driving Licence Code. This can be found at https://www.gov.uk/view-driving-licence and requires you to input your driver number and national insurance number in order to generate the unique code.
– Copy of V5
– Trading Accounts
– Purchase Receipt
– Copy of Order Books for period prior to theft
– Details of any vehicle finance

[[[["field186","equal_to","No"]],[["show_fields","field8"]],"and"],[[["field188","equal_to","No"]],[["show_fields","field27,field28,field29,field30,field31,field32,field33,field34,field36,field37,field38,field190"]],"and"],[[["field188","equal_to","Yes"]],[["hide_fields","field178,field211"]],"and"],[[["field47","equal_to","Yes"]],[["show_fields","field48"]],"and"],[[["field74","equal_to","Yes"]],[["show_fields","field75"]],"and"],[[["field76","equal_to","Yes"]],[["show_fields","field77"]],"and"],[[["field78","equal_to","Yes"]],[["show_fields","field79"]],"and"],[[["field80","equal_to","Yes"]],[["show_fields","field81"]],"and"],[[["field84","equal_to","No"]],[["show_fields","field85,field87,field88,field89,field90"]],"and"],[[["field193","equal_to","Yes"]],[["show_fields","field95,field96,field97,field98,field99"]],"and"],[[["field194","equal_to","Yes"]],[["show_fields","field100,field101,field102,field103"]],"and"],[[["field260","equal_to","Yes"]],[["show_fields","field153"]],"and"],[[["field151","equal_to","Yes"]],[["show_fields","field152,field153,field154"]],"and"],[[["field191","equal_to","No"]],[["hide_fields","field178"]],"and"],[[["field5","equal_to","Yes"]],[["show_fields","field207"]],"and"],[[["field188","equal_to","Yes"]],[["set_value",null,"-",null,"field27"],["set_value",null,"-",null,"field28"],["set_value",null,"-",null,"field29"],["set_value",null,"-",null,"field30"],["set_value",null,"-",null,"field31"],["set_value",null,"-",null,"field32"],["set_value",null,"-",null,"field33"],["set_value",null,"-",null,"field34"],["set_value",null,"-",null,"field213"],["set_value",null,"-",null,"field38"]],"and"]]
1 Step 1
Policy Number
Claim ReferenceIf known
Section One - Policyholder
Name
Date of Birth
VAT Registration Number
Trading Title
Private Address
0 /
Business Address
0 /
Full Time Occupation
Any Part Time Occupation
Please provide documentary evidence of order book and / or deliveries per the month before loss and copy of trading accounts.
Upload
Private Tel
Business Tel
Mobile Tel
Paste copy of your unique DVLA code.Please supply photo ID and the unique code to view and secure a copy of your license history from the DVLA. This can be found at https://www.gov.uk/view-driving-licence  and requires you to input your driver number and national insurance number in order to generate the unique code. Please paste the unique code which has a one time access within a 21 day time period below.
Driving licence photo ID
Upload
Please give details of all previous convictions including non-motoring convictions (which are not spent) any convictions pending and any County Court Judgments. If none, state none.
Date of ConvictionConviction Type and CircumstancesFine / Sentence
×
×
(2)
Please give details of previous accidents/claims/losses. If none, state none.
Date of IncidentCircumstancesCost
×
×
(2)
Give details of any physical defects or infirmities
Has Insurance ever been cancelled or refused?If yes, provide details
If yes, give insurers details
0 /
Section Two - Driver (or last permitted driver) details
Namefull name
Dateof Birth
Address
0 /
F-T Occupation
P-T Occupation
Private Tel
Business Tel
Mobile Tel
Paste copy of your unique DVLA code.Please supply photo ID and the unique code to view and secure a copy of your license history from the DVLA. This can be found at https://www.gov.uk/view-driving-licence  and requires you to input your driver number and national insurance number in order to generate the unique code. Please paste the unique code which has a one time access within a 21 day time period below.
Driving licence photo ID
Upload
Relationship to Policyholder
Please give details of all previous convictions including non-motoring convictions (which are not spent) any convictions pending and any County Court Judgments. If none, state none.
Date of ConvictionConviction Type and CircumstancesFine / Sentence
×
×
(2)
Please give details of previous accidents/claims/losses. If none, state none.
Date of IncidentCircumstancesCost
×
×
(2)
Give details of any physical defects or infirmities
Has driver ever had Insurance cancelled or refused?If yes, provide details
If yes, give insurers details
0 /
Section Three - Particulars of vehicle / ownership
Vehicle Make / Model
Registration Number
Date of Registration
Engine Size
Colour
Mileage
Current Value
Date of Purchase
Price Paid
Payment Method
How many keys were provided with the vehicle when purchased?
Have any keys been cut for the vehicle since you purchased it?If yes, how many?
Please provide details of all key holders
0 /
Did anybody else have access to the keys at the time of theft?
Name and Address of person/company from whom vehicle was purchased
0 /
MOT Reference No.
If yes, give full details
0 /
If yes, give full details
0 /
What was the general pre-incident condition of the vehicle
Give details of any recent repair / maintenance work on the vehicle
0 /
Does the vehicle have any distinguishing features?
0 /
Give details of any HP or finance company interest in the vehicle
0 /

If no, please state the details of the registered owner of the vehicle.

Name
Relationship to Policyholder
Address
0 /
Telephone No.
Timevehicle came into your possession
Datevehicle came into your possession
For what purpose was the vehicle in your possession?
When were you due to hand back the vehicle?
What work had been carried out on the vehicle?
0 /

If yes, please clarify the following.

Who paid for the vehicle?Insured / Named Driver / Other
What is their relationship to the vendor?(if any)
If log book is not in the vendors name state reason, if known
Upload V5 and purchase receipt
Upload
Section Four - Details of Theft / Fire
Date
Time
Locationyou can type the rough address and specify further by dragging the pin on the map
Distance from trade premisesif applicable
If incident occurred on premises state type of property
Who owns the premises?
How long had the vehicle been parked at the location of loss?
For what purpose was the vehicle parked there?
When was the last time you saw / drove the vehicle?
When did you intend to collect the vehicle / drive it again?
What action was taken to secure the vehicle?
Were all doors / windows locked and in working order?
Who had the keys at the time of loss?
Were the keys in the ignition?
Was the vehicle fitted with an alarm / immobilizer?
Was it engaged?
State Make and Model (please supply copy of installation certificate)
Please upload a copy of the installation certificate
Upload
When and by whom was the loss discovered?
Was there any signs of forced entry and the scene?
Please describe in detail using times, dates and places to assist, everything from the last time that you used the vehicle up until it was discovered missing and the loss was reported
0 /
In your opinion, how do you think that the vehicle was stolen?
Please state names and addresses of any other person having knowledge of the circumstances of the loss.
NameAddress
×
×
(2)
Do you have any suspicions as to who could have perpetrated the loss and have you advised the police of your suspicions?
Was the vehicle involved in an accident whilst it was stolen? If yes, give details
Section Five - Recovery of Vehicle
State fully who discovered the vehicle and arranged for its recovery. Include all relevant information.
If comprehensive cover please upload two competitive estimates
Upload
Describe damage to vehicle
0 /
Upload any images showing damage to the vehicle
Upload
If you have not received a quote what is the estimated cost of repair
Where can the vehicle be inspected?
0 /
When can the vehicle be inspected?
Name of repairer
Address of repairer
0 /
Telephone Number of repairer
Section Six - Police Details
If yes, please provide the name and address of station.
0 /
If yes, please provide the name and collar number of this officer
Name of person who reported the theft
Datereported
Timereported
Crime Reference
Have any suspects been apprehended?
Section Seven - Additional Information
Please provide any additional information which may be helpful to us in dealing with your claim.
0 /
Section Eight - Declaration
Please read carefully before signing
I hereby confirm that the above information is a true and accurate statement. Unless Red Seal Resources hear from you to the contrary within the next 24 hours the above contained information will be deemed to be a true and accurate record of events.
I declare that the above statements are true and correct to the best of my knowledge and belief. I hold no other policy in addition to this one indemnifying me in respect of this claim. I have not withheld from the Insurers any information with my knowledge connected with the loss and I agree to provide the Insurers with any further information or documentation as may be required. I hereby confirm that Red Seal Resources Ltd have my authority to recover any outlays on my behalf for monies paid under this contract of insurance in relation to this event. If my vehicle is a total loss I agree that the company may have my permission to remove the vehicle to safe and free storage pending settlement of this claim. I understand that any attempt to make a fraudulent claim may result in prosecution.
Signatureof driver or last person in charge of vehicle
Signatureof Policyholder
Dateagreed
Dateagreed
Agreement
If you are having trouble submitting the form then please reload your page and try again.
Previous
Next