Teepee Claims
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Covid-19
Contact Us
About
Report a Claim
Sectors
Testimonials
Careers
Covid-19
Contact Us
Social Media
Facebook
Twitter
Instagram
Contact Us
0800 368 9328
info@teepeeclaims.com
Report a Claim
Claim Form
Name of Broker / Fleet
Name of Person Completing Claim Form
Email Address
Your Client's Details
Vehicle Owner / Company Name
Contact's Name
Contact's Phone Number
Driver's Name
Driver's Phone Number
Vehicle Registration
Vehicle Model
How many vehicles involved?
0
1
2
3
4 or more
Details of the other party involved in the accident
Full Name
Phone
Vehicle Registration
Vehicle Model
Insurance Company
Policy Number
Where did the accident happen?
Address
Street Address
Address Line 2
City
ZIP / Postal Code
What happened?
Other vehicle hit my car from behind
Other vehicle pulled out of a giveway into the road I was driving from
Other vehicle hit my parked car
Other vehicle pulled out from a parking space and hit my car
Other vehicle turned across my path
Other vehicle changed lanes and hit my car
Other vehicle hit my car on roundabout
Other vehicle hit my car head on
Different circumstances from those listed above
Additional Accident Details
Did the police attend?
Yes
No
CCTV or dashcam footage available?
Yes
No
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COVID-19 Contingency Plan For Brokers
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