ULR policy form

Please note that it is important to provide all receipts / documentation by post, where available.

Have you sustained:

Please note: you may be liable for the Hire Car charges should you fail to notify us.

If your answer is no and legal proceedings are issued, the court will request proof that you did not have the financial means to pay for your own hire vehicle at the time of the incident.

Please provide a clear breakdown of how your loss is calculated and supply any supporting documentation to us via email or post quoting your name and reference number.

Please provide a clear breakdown of how your loss is calculated and supply any supporting documentation to us via email or post quoting your name and reference number.

Please note: You can only claim loss of use if you were without a vehicle.

Please provide a clear breakdown of how your loss is calculated and supply any supporting documentation to us via email or post quoting your name and reference number.

If solicitors are acting on your behalf please give their details including reference:

Please note that depending on the answers given above, you may be required to sign a statement at a later date.

Please proceed to press the submit button below and the completed form will be sent to us.

As you have completed the form electronically you do not need to send a paper copy or call to confirm the details.