Motum Insurance Services

ONLINE CLAIM FORM

Please DO NOT use this service if you require immediate assistance or you are at the roadside. Please call on 0345 241 4105 for immediate/roadside assistance

Please complete the details as fully & accurately as possible

Salutation

Full Name (Driver)

Date of Birth

Time Held Licence

Licence Type

Policyholder

Policy Number

VAT Registered

Address

Phone

Vehicle Registration

Vehicle Damage

Date of Incident

Time of Incident

Incident Location

Who is at fault?

What happened?

Tell us what happened in the incident

Other Party Name

Other Party Phone Number

Other Party Address

Other Party Registration

Other Party Make/Model

Witness Name

Witness Telephone Number

Important - The information you provide above will form the basis of your claim, it is therefore important you provide full & accurate details failure to do so may result in your insurer declining your claim.

Motum Insurance Services

1-2 Grafton Court

Kettering Venture Park

Kettering NN15 6XR

Privacy Notice

Motum Insurance Services is a trading name of Horizon Vehicle Management Ltd. Horizon Vehicle Management Ltd is authorised and regulated by the Financial Conduct Authority (Firm Reference Number 929035) in respect of insurance distribution . You can check our status on the Financial Services Register at https://register.fca.org.uk/s/. Registered Office in England at our address Suite 4, New Humberstone House Suite 4, New Humberstone House, 40 Thurmaston Lane, Leicester, England, LE5 0TE. We are registered in England and Wales (registration number is 10487129. We are registered with the ICO (registration number ZA218450).

It is our intention to provide you with the highest possible level of customer service at all times. However we recognise that things can go wrong on occasion and if this occurs we are committed to resolving matters promptly and fairly. Should you not be satisfied with our final response, you may be entitled to refer the matter to the Financial Ombudsman Service (FOS). More information is available on request or on their website, www.financial-ombudsman.org.uk.