You should download the Motor Accident Report Form. Click here
Section 1 – Insured
This section applies to the policyholder. This is the person whose name is on the policy.
Section 2 – Driver of Insured’s Vehicle
This section applies to the person who was in charge of the vehicle at the time of the accident. Please note the following:
- Driving licence number:
This is found under the Driver Number heading on your licence.
- Vehicle groups:
This is the category of vehicle you are licensed to drive. Eg. a private motor car is Category A.
- Are you the owner of the vehicle?
This is the name of the person recorded on the Vehicle Licensing Certificate.
- If this is not your vehicle do you have a motor policy in your own name?
This is a question to clarify if there are other insurance policies that may apply.
Section 3 – Insured’s Vehicle
This section applies to the vehicle involved in the accident.
- Was the vehicle being used for hire or reward?
This is asking you if you received any payment for using the vehicle, whether monetary or non-monetary
- Has the vehicle been modified?
This is asking you if the vehicle adheres to the manufacturer's specification or if it has been altered in some way
- Is the vehicle the subject of a Leasing Agreement?
This refers to any lease or finance agreement (such as hire purchase) on the vehicle
Section 4 – Damage to Insured Vehicle
This section should be completed – whether you are claiming for damage or not.
Section 5 - Details of the accident
This should be completed by the person in charge of the car at the time of the accident. Provide as much detail as you can. This will enable us to make the right decision on who was at fault or what additional enquiries are needed to make that decision.
Whom do you consider to be at fault and why? A clear response to this question is important.
Section 6 - Witnesses
Details of all witnesses to the accident and names of Gardai who attended the scene are important to establish who was at fault.
Section 7 - Other Parties Involved
Information relating to other parties involved:
- any injuries caused to them
- any damage caused to their vehicles
- any damage caused to their property
The claim form must be signed and dated by the policy holder. It must also be signed and dated by the driver of the car (if this is different from the policyholder).