Car Insurance

Car claims notification form

Important, please tell us…

Was anyone injured in this incident?
Yes
Does your claim involve just windscreen damage?
Yes

All fields marked with a * are mandatory.

About you

What is your first name? * :

What is your surname? * :

And are you...(find out who can claim) * :

What is your preferred telephone number? * :

What's your email address? * :

Please confirm your email address? * :

What's your policy number? * :

What is your contact preference? :

Telephone
Email
Letter

About your claim

What is the car's registration number? * :

When did this claim happen? (dd/mm/yyyy) * :

What sort of claim is this? * :

Where did this claim happen? (eg Junction 9, A11, Thetford, Norfolk) * :

Were the emergency services involved? (tick all that apply) :

Police
Ambulance

What was the police reference number? (if known) :

If you would like the vehicle to be repaired by an Aviva approved repairer, please enter the postcode for the vehicle's residence overnight (nearest postcode eg NR1 3NS) :

Were you in charge of the vehicle at the time of the incident? * :

Please provide the personal/address details of the driver.

First name:

Surname:

Please provide the following additional personal details.

Date of birth (dd/mm/yyyy): *

House number/name: *

Street name: *

Town/city: *

Postcode: *

About the theft

What type of theft was it? :

Do you need a replacement (tick all that apply) :

Glass
Car Stereo (Radio, CD etc.)

Does you car have any security? :

Was this security activated/on at the time? :

About the damage to your car

Image Upload

Image upload

You can upload images you have of the damage to your car.

The images must be under 500Kb in size.

Upload 1 :

Upload 2 :

Upload 3 :

Upload 4 :

Upload 5 :

About the third party

Do you have any details about the third party involved? :

What is their first name? :

What is their surname? :

Who is their insurer? :

What's their policy number? :

What is the car's registration number? :

What is their daytime telephone number? :

What is their postcode? :

What is their house name or number? :

If you have any other details about any third party involved please enter them here. :

Anything else

Please let us know about your claims circumstances? :

Download the Aviva MyClaims app - scan this barcode to open the iTunes App Store

Need help?

Look for the Help symbol and click it for help on how to fill out this form.

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Contact us

0844 891 1111

New claims
24 hours a day, every day

Existing claims
Monday to Friday: 9.00am - 5.00pm
Saturday/Sunday: Closed

0844 numbers will be charged at 3p per minute from a BT landline. Calls from other networks may vary.

For our joint protection, telephone calls may be recorded and/or monitored

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Car Insurance

Car claims notification form

Important, please tell us…

About you

About your claim

About the theft

About the damage to your car

Passenger side:

Drivers side:

Car centre:

Image upload

About the third party

Anything else

Need help?

Contact us

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