Motor Theft Claim

No 2 The Colosseum Building
Century City  Boulevard

 Century City

PO Box 90 Century City 7446
Tel: (27) (21) 529 7800 
Fax: 0865 202 355
E-mail: insure@aib.co.za
 Insured
Name
Surname
Address
Telephone
Fax
E-mail
Identification Number
Policy Number
 Vehicle
Make
Model
Year
Registration
Kilometers Completed
Purchase Date
Purchase Price
Anti-theft device make
Anti-theft device fitted by and date
Window markings number
Window markings applied by whom
Finance company and branch
Type of agreement
Account Number
Amount
In whose name is vehicle registered? (Please fax us a copy of registration certificate)
 Theft Details
Date and time of theft
Place of theft
What was stolen Vehicle and accessories
Accessories only
Other
Vehicle, accessories and other
Details of stolen accessories (Please fax invoices to us)
Police Station and reference number
Circumstances of theft
Was vehicle locked? Yes    No
 Identification
Chassis Number
Engine Number
Component Numbers
Exterior colour
Interior colour
Details of scratches/dents/defects
Details of personal/hidden identification marks
Details of other features which would assist identification
Who is in possession of vehicle keys?
 Authority for payment
It is recommended that any amount payable to you directly be transmitted by Electronic Bank Transfer for speedier settlement and security reasons.
Do you agree to this? Yes     No
 Signature
Name
Signature
Please print the completed form and fax the signed document to 0865 202 355