Garage Claim Registration

Policy/CN/ECN/BQA Number*

Registration Number

Model & Variant

Customer Name

Email Id

Contact Number*

Third Party Property/Bodily injury*

Nature of Loss*

Location of Accident*

Description of Accident*

Was Vehicle Parked at the time of loss?*

Driver License Number*

Accident Date & Time*

HH*

MM*

Damaged Parts*

Driver Name*

Driver's Relationship with Insured*

Workshop Search By*

Workshop Alternate Number

Remarks

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