Revised Inspection Form - Northern Assessors

Inspection Form

The following form is only to be used if you DO NOT have access to our Claim Portal, please contact us if you need a user name and password issued for the Claim Portal

Please fill in the online form below to submit your instruction.

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Contact Details

Company Name*

Contact Name

First Last

Email*

Phone*

Policy/Claim Number*

Address*

Street Address Address Line 2 City Post Code

Inspection Details

Please provide details of the vehicle to be inspected.

Type of Inspection Required*

Which Vehicle To Inspect*

Registration Number of Vehicle to be Inspected*

Vehicle:*

Make/Model

Client Details

Provide the contact details for the keeper of the vehicle to be inspected.

Name*

First Last

Address*

Street Address Address Line 2 City Post Code

Contact No*

Cover Detail

Type of Insurance Cover

Policy Excess Applicable*

Excess Amount

VAT Registered

Incident/Theft Date*

May We Authorise Repairs On Your Behalf?*

Images Required? :*

In Use? :*

Scheduled / Agreed Value

Estimate

Paint and Materials

Rec

Lab

Telephone No

Notes

Comment / Accident Circumstances*

If no credit arrangements are currently in place, please contact our office to make arrangements on 01484 864430.

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Comments

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