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Warranty Claim Form
Please complete all the required information an upload the supporting documents
Title
*
-- Select --
Mr
Mrs
Ms
Dr
Prof
Hon
Full Names
*
Last Name
*
ID Number
*
Policy Number
*
Insurance Company Name
*
Date of Loss
*
YYYY dash MM dash DD
Vehicle Registration Number
*
SAPS Case Number
*
Contact Details
Contact Person
*
Comments
Contact Number
*
Upload Documents
Each file upload to not exceed 2MB.
Affidavit stating theft circumstances
*
Accepted file types: pdf, jpg, gif, png, jpeg, Max. file size: 2 MB.
Insurance Claim Form
*
Accepted file types: pdf, jpg, gif, png, jpeg, Max. file size: 2 MB.
Driver’s Licence
*
Accepted file types: pdf, jpg, gif, png, jpeg, Max. file size: 2 MB.
SAPS Form 21 & Non-recovery Report
*
Accepted file types: pdf, jpg, gif, png, jpeg, Max. file size: 2 MB.
Insurance Settlement Agreement
*
Accepted file types: pdf, jpg, gif, png, jpeg, Max. file size: 2 MB.
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Email
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