BBi Berns Brett Claims Reporting Services

Motor Claims Reporting Services
If you need to make a claim fill in the form below,
email us here or contact us by telephone on 0800 3588 222.

SECTION 1 - Policyholder's Details

Title
Full Name
Number & Street
Area/Town
City/County
Postcode
Telephone Number
Mobile Phone
Fax Number
Email Address
Berns Brett Client No.
Policy No.
Your Insurance Company

SECTION 2 - Vehicle Details

Make
Model
Registration No.
Year First Registered
Engine Capacity
Does the policy holder own the vehicle
If not, give owner details
Was the vehicle used on policy holders order or with permission
For what purpose was the vehicle being used
If a commercial vehicle
What is the Gross Vehicle weight
What is the Carrying Capacity

SECTION 3 - Driver's Details

Title
Full Name
Number & Street
Area/Town
City/County
Postcode
What type of license do they/you have
Driving test, pass date
Date of Birth
Permitted Groups
If driver is not the policyholder:
Relation
Has the driver been convicted of any motoring offence within the last 5 years
If yes, give details
Has the driver been involved in an accident in the last 5 years or is any prosecution pending
If yes, give details
If a private car, who is the main user

SECTION 4 - Damage to Policyholder's Vehicle

If we cover the damage to your vehicle a Recommended Repairer Scheme, offers the advantage of guaranteed repairs. Please ask us about the most suitable repairer for your particular vehicle.
Details of the Damage
Is this vehicle still in use
Have you authorised repairs
Where may our engineer inspect the vehicle (include Telephone No.)
Are you registered for VAT
What percentage can you recover
If you are registered, do you authorise us to instruct repairs on your behalf
The V.A.T. content of the repair account is payable by you to the extent that you can recover the tax.

SECTION 5 - Witnesses

Please forward by post, a sketch showing road widths, traffic lights, signs etc.
Name, address and telephone of Witness 1
Name, address and telephone of witness 2

SECTION 6 - Circumstances of Accident

Date of Accident
Time of Accident
Speed
Exact Location of Accident (Road, Town etc.)
If police were called, give details (Station, No etc.)
Give details of what happened

SECTION 7 - Other parties involved and property damage

Name and address of owner and, if appropriate driver
Registation No
Insurer's Policy No.
Insurer's Name
Insurer's Address
Apparent damage
If you or your passengers were injured:
Name(s) and address(es).
Injury
Were you and your passengers wearing seat belts
Is this person employed by you
If any other people were injured:
Other Name(s) and address(es)
Nature of injury to others
Please tick the box to agree that the information supplied in this form is accurate to the best of your knowledge/belief.
All information supplied is used by Berns Brett Ltd for underwriting purposes.