MORIS
Trackday Insurance

CLAIM NOTIFICATION

GENERAL - PLEASE READ THIS SECTION FIRST
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ACCIDENT REPORT
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 Accident Report Form link to complete this form.
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THIS FORM
Complete and submit this form no later than 48 hours after the date of the incident.
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INFORMATION
Answer EVERY question. If you cannot supply all information now, provide an explanation at the bottom of this form.
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PHOTOGRAPHS
These MUST be taken at the circuit prior to dismantling. If you do not do this, your claim will NOT be paid!
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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: click on calendar to choose date
Time of Accident:
Circuit:
Name of Corner on Circuit:
Was there any damage caused to circuit? Yes   No
Was there an instructor in the car at the time of 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:
Weather Conditions / Track Surface:
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:

Declaration
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: click on calendar to choose date