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Motor Theft Notification
Motor Theft Notification
INSURED
(Required)
POLICY NO
(Required)
ADDRESS
(Required)
CONTACT PHONE
(Required)
VEHICLE DETAILS
Make/Model
(Required)
Make/Model
(Required)
Year
(Required)
Please enter a number greater than or equal to
1900
.
Mileage
(Required)
Please enter a number greater than or equal to
0
.
Radio – Make / Model & Year
(Required)
Speedometer
(Required)
Alarm Fitted
(Required)
Yes
No
Amount of Fuel
(Required)
Please enter a number greater than or equal to
0
.
GENERAL INFORMATION:
N.B. “Operator” means person in whose custody keys were at the time of the theft.
Operator’s Name
(Required)
Contact Phone
(Required)
Address
(Required)
Did he have Insured’s permission to operate vehicle?
(Required)
Yes
No
For what purpose was vehicle being used describe?
(Required)
Date reported to Police
(Required)
MM slash DD slash YYYY
Date reported to Police
(Required)
Date reported to Police
(Required)
IR
RRB
NB certified copy of initial Police Report containing driver’s statement must be attached
Was vehicle securely locked?
(Required)
Yes
No
Are keys still in your possession
(Required)
Yes
No
Please give details
(Required)
Is the vehicle on hire purchase
(Required)
Yes
No
Please give details
(Required)
Hire Purchase amount owing
(Required)
Please enter a number greater than or equal to
0
.
Hire Purchase amount owing to whom?
(Required)
Is vehicle insured with any other company?
(Required)
Yes
No
Colour of Vehicle
(Required)
Any visible marks that will assist in identifying vehicle
(Required)
Do your suspicions rest on someone?
(Required)
Yes
No
Please give details
(Required)
LOSS DETAILS
Detailed statement or circumstances leading to theft of vehicle
(Required)
Date of Theft
(Required)
MM slash DD slash YYYY
Time
Hours
:
Minutes
AM
PM
AM/PM
Place of Theft
(Required)
Town
(Required)
Decralation
I (full name on Insured/Operator) hereby declared that and that the foregoing information is true and correct
Date
MM slash DD slash YYYY
About AFC Holdings
Institutional Overview
Vision, Mission & Values
Board Of Directors
Executive Management
Investments
Tenders
Careers
Commercial Bank
Land & Development Bank
Leasing
Insurance
Media Centre
Press Release
Gallery
News & Updates
