Trackday Motorsport accident damage insurance claims notification procedure

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Claims: Trackday - Cars -> Notification

GENERAL - PLEASE READ THIS SECTION FIRST

Complete and submit the form below no later than 48 hours after the date of the incident.

1. ACCIDENT REPORT FORM - It is necessary that you obtain an independent statement from a circuit official confirming the location, date and time of the accident. Please click on the Report Form link on the left to complete this.
2. INFORMATION - Answer EVERY question. If you cannot supply all information now, provide an explanation at the bottom of this form.
3. PHOTOGRAPHS - These MUST be taken at the circuit prior to dismantling. If you do not do this, your claim will NOT be paid!
4. CLAIMS PROCEDURE - For full Claims Procedure please click on the Claims Procedure link.

Your Details

TD Reference:
Name of Driver involved in accident:
Tel:
Fax:
Email:

The Event

Date of Accident:
Time of Accident:
Circuit:
Name of corner on circuit:

Was there any damage caused to circuit?	Yes No
Was the instructor in the car during the accident?	Yes No
Were You / The Driver hurt?	Yes No
Did You / The Driver receive medical attention?	Yes No

If 'YES' please give details:
Track Conditions:
Details of how accident occurred:
Parts damaged:
Rough estimate of repair costs:	£ no commas or spaces

Inspection Address

Please advise us of the current whereabouts of this vehicle in case we wish to carry out an inspection:
If you think that there is any other information that we should be aware of, please enter your details here:

In submitting this electronic claim form, I/we declare that the above statement and particulars are true and complete to the best of my/our knowledge and belief and that no material facts have been withheld, misrepresented or misstated.

Name: Date: