CLAIM FORM

Your claim request with Ref No: send successfully. We will get back to you within 24 hrs.
The above reference no is only a no and does not mean claim has been registered. It only means submission of documents and information client should wait for claim no. Claims no will be generated by verifying documents.
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Date of Accident   Driver Name
Place of Accident   Customer Email ID
Vehicle No   Preferable Location for Garage Repair
Oriental Policy No   Date of Birth
Police Report No   Mobile No
License No   Garage/ Broker Email (For Garage/ Broker Use Only)
D/L Issue Date   D/L Expiry Date
Mulkiya Expiry   Police Report
License - (Front Copy)   License - (Back Copy)
Mulkiya - (Front Copy)   Mulkiya - (Back Copy)
EmiratesID - (Front Copy)   EmiratesID - (Back Copy)
For Towing and Roadside Assistance contact International Motoring Club on 8004101
I/we the above named do hereby, to the best of my/our knowledge and belief, warrant the truth of the foregoing statement in every respect that I/We have made or in any further declaration the Company may require to make in respect of the said accident. If in case I/we make any false or fraudulent statement with any suppression or concealment, the Policy / claim shall be void and all rights to receive thereunder in respect of this or future accident shall be forfeited.
I agree to the above Terms and Conditions