SASTUA Motor Accident Claim Form

Motor Accident Claim form note: Each page should be completed in full, where applicable please advise (n/a)

Type of Policy *PersonalCommercial / Agri

Address *

Date and Time of Loss / Damage Occurred *

When was the Loss / Damage Discovered *

Were premises Occupied? * YesNo

Loss / Damage occurred by Third Party? * YesNo

Have you previously suffered a Loss / Damage? * YesNo

Type of Loss * Own DamageTheft / DamageThird PartyMalicious Damage

Does any other party have an interest in the insured property, eg. Credit agreement? * YesNo

Estimated total value of all property insured under the policy *

Please select the amount of items you want to claim for: *

Damage Report *

Replacement / Repair Quotation *

Photos of Damages 1 *

Photos of Damages 2 *

Proof of ownership (in the event of theft)

Claim Form Completed By * Broker / AdminClient

Signed Date *

Signature *

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