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Motor Accident Claim form

Vehicle Details

Description of Damage to Own Vehicle

Driver Details

Passengers (Insured Vehicle)

If any passengers in the insured vehicle were injured, complete this section.

Other Parties

Other Vehicles

Property Damaged Other Than Vehicles

Witness to the Accident

Accident Details


A sketch of the accident will have to be emailed to Dynamicz in order for your claim to be submitted. Other Documents Required (Passport/ ID, Drivers License, Case Number, Photos if Applicable)