London Car Rentals Fleet Showcase - default banner
london

car rentals

Quality Car, Van, Minibus, and People Carrier Hire Services
READ MORE

Accident Report Form

Policyholder (Rental Company)

















Vehicle























Use



 Yes No



 Yes No



 Yes No



 Yes No



 Yes No



 Yes No

Driver or last person in charge of vehicle (even if vehicle was parked and left unattended
THIS SECTION MUST BE ANSWERED

















Has Driver



 Yes No



 Yes No



 Yes No



 Yes No

If yes answered to any of the above questions, give details below
Third Party Vehicle(s)

























Third Party Propert







Injuries



































 Yes No



 Yes No



 Yes No



 Yes No



 Yes No

If the policy covers the damage sustained by your vehicle and same remains in use, please obtain and forward more than one estimate for our consideration.

If repairs will not be economic we may wish to move the vehicle to safe and free storage. We should appreciate your permission to do this. If you decline you could become liable for any additional charges which are then incurred.

May we move the salvage?
Damage to third Party vehicle(s)



 Yes No









 Yes No







Accident details













 Good Poor None



 Town Village





Speed of vehicles:





What warning or signal was given by :





What was the condition of the :





What lights were displayed by :







 Yes No



 Yes No

Circumstances

Please describe the accident circumstances and make a sketch showing positions of vehicles and direction of travel. Please show all road signs and markings. (If you need more space please use a separate sheet of paper and attach it to this form.)

Who, in your opinion, was to blame?



 Yes No

Witnesses
Names and addresses of:





You are reminded that the policy conditions require that every letter, writ, summons and process must be notified or forwarded to insurers immediately on receipt. You must also tell us of any impending prosecution, inquest or fatal injury. Do NOT attempt to deal with any Third Party claim yourself or make any offer or admission of liability.

Insurers pass information to various anti-Fraud and Theft Registers. The aim is to help us check information provided, and also to prevent fraudulent claims. Under the conditions of your insurance policy, you must tell us about any incident (such as an accident or theft) whether or not it gives rise to a claim. When you tell us about an incident, we will pass information relating to it to the registers.

I/WE HEREBY DECLARE that the above statements are true to the best of my/our knowledge and belief, and that the vehicle is not insured except with LIBERTY SYNDICATE MANAGEMENT LIMITED. I/We understand that you may ask for information from other insurers to check the answers I/we have provided.





Avail of more of our special promotions by signing up for our mailing list.
We provide discounts and various exclusive benefits for a premium rental experience.


*rest assured we will never spam you