How to make a claimAre you a Repairer or Dealer? I am a repairer/dealer adding a fully itemised estimate. Please note, your estimate must include the following: customer name, address, contact number, vehicle registration number and if known, the customer schedule number. If your estimate does not include this information, please complete the form below.If the vehicle is showing signs of imminent failure, DO NOT CONTINUE TO USE IT. This may cause further damage for which you will be responsible. We will not pay for any stripping down of parts to determine the cause of failure unless we accept the claim. The maximum we will pay in total is shown on your schedule. Take your vehicle to the supplying dealer, or if they do not have a workshop, to a local repairer of your choice. DO NOT proceed with any repairs on this vehicle until the claim is authorised by the Administrator. Any repair completed without authority will not be accepted. What Happens Next? Once we have received your claim, we will notify you if we require any further information and we will keep you up-to-date on how your claim is progressing. Please refer to your warranty documentation, in the How To Make A Claim section. Failure to follow this procedure may mean that we are unable to process your claim. Please complete the claim form fully, including attaching any documents or images that may be requested. Failure to provide all information at this time may mean that we are unable to process your claim. Payment When the repairs have been completed, You should email the invoice to the Administrator quoting the authority number given prior to the commencement of the repairs. The invoice must give full details of the repair including all parts used in the authorised repair, labour and VAT. Invoices should be emailed to invoice@mbginsurance.com Your DetailsBefore completing the form, please ensure you have read your documentation fully. We recommend you have the documentation to hand to help you complete the form. To complete the form you will require: Policy / Warranty Documentation Details of the repair costs or estimate Your vehicle details including current mileage Date Fault Noticed*The date you very first noticed the fault Date Format: DD slash MM slash YYYY Date of Incident* Date Format: DD slash MM slash YYYY Schedule NumberThe Unique Reference Number shown on your Policy ScheduleCustomer Name*Your First and Last Name as registered to the Policy or Warranty First Last AddressThe address to which your Policy or Warranty is registered Street Address Address Line 2 City Region Postcode Telephone*Telephone Number and Area CodeMobileTelephone Number and Area CodeEmail AddressA current e mail address by which we can contact you Is Your Claim Urgent?*YesNoWhy Is Your Claim Urgent?Breakdown DetailsRepairer Name*The name of the Firm carrying out the repairs to your vehiclePhoneTelephone Number and Area CodeEmailA current e mail address by which we can contact the repairer VAT Registered?YesNoVehicle Registration Number*If your vehicle has a private plate, please enter that and the original vehicle registration as we require both to process your claim.Private Plate? Yes, my vehicle has a private plate. Original Vehicle Registration NumberThe VRM at time of first registrationMakeThe vehicle Make e.g. VolkswagenModelthe vehicle Model e.g. GolfCurrent Mileage*The mileage at time of repairWater Ingress?CaravanMotorhomeLocation of Damage Roof Nearside Panel (General) Nearside Hatch Door Offside Panel (General) Offside Hatch Offside Wheel Offside Window Offside Vent Nearside Window Rear Bumper Rear Panel Rear Window Front Panel Front Bumper Nearside Wheel Location of Damage Bonnet Front Bumper Nearside Rear Wheel Nearside Front Wheel Rear Bumper Skylight Side Door Nearside Panel (General) Nearside Window Nearside Hatch Cab Roof Camper Roof Rear Panel Fault Description*Please list any additional circumstances which you wish us to consider when processing your claim.Cause of Failure*The reason the Fault has occurredDiagnostic CodeDiagnostics will only be accepted as part of a valid claim and if covered.Diagnostic Report Available?YesNoAdd Diagnostic Report Drop files here or Accepted file types: jpg, gif, png, pdf, doc, docx. Our file upload accepts jpg, gif, png, pdf, doc, docx files. Individual file size is limited to 16mb.Parts Required*(Please itemise parts required, quantity and cost per item or attach estimate. Please include part name and number.Complete below, or attach PDF of fully itemised estimate.PartQuantityCost Per Item (Pre VAT) Total CostPart Numbers and Labour Operation CodesPlease include part name and number.Your EstimateEstimate or Service History Upload Drop files here or Accepted file types: jpg, gif, png, pdf, docx, doc, rtf. Vehicle mileage*Labour Rate (per hour)*The Total labour rate per hour to be charged for the repairHours Required*The number of hours required to complete the repair.Hours Required*The number of hours required to complete the repair.DeclarationPlease check all your answers carefully before submitting your claim.Confirmation* I hereby certify that all the information given in this form is truthful, accurate and complete. Dated Date Format: DD slash MM slash YYYY Please be aware that a fraudulent or exaggerated claim may result in a complete loss of any entitlement under the policy. Please note; Our privacy policy can be found here.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
