Breakdown Insurance Claim Form

Submit your claim

Page: Claims - Breakdown

"*" indicates required fields

Please fill in the details below as accurately as possible to help us progress your claim
DD slash MM slash YYYY


Electronic item

Details and cause of damage/breakdown

Insurance history

Do you have a supporting quote, invoices or photo’s that will assist us to lodge your claim with your insurer? (If yes – please email these to
This field is for validation purposes and should be left unchanged.