Car Accident - Claiming Against an Aviva Customer

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About your Claim

Please enter the date in the format dd/mm/yyyy

Please insert as 24 hour (e.g 13:52)

Did the airbags deploy?

Additional Details (to help us process the claim faster)

Were the Gardai notified?
Did the Emergency Services attend?
Please select all the emergency services that attended the accident
Do you give permission for our investigator to contact you?
Do you give permission for your vehicle to be inspected?
Is there any CCTV in the surrounding area?

Your Vehicle Details

Is there finance on the vehicle?
Is the vehicle drivable?
Is the vehicle in storage?
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Please format as below

Company Name _________ Policy Number _________

Passenger Details

Were there any passengers?
Were they injured?
Were there any witnesses to the accident?

Additonal Details

Was anyone else (aside from the Aviva insured vehicle) involved or affected by the accident?
Please select all that apply for the type of involvment

Your Details

Were you the driver of the vehicle?

Please specify your relationship to the policyholder.

Are you the owner of the vehicle?

Please specify your relationship to the policyholder.

Aviva Customer Details

Policy Number (optional)

If you submit this form outside our normal working hours, we may have team members available from 8am on the next working day.

Please confirm below if you consent to Aviva contacting you between 8am and 9am if staff are available

Claim Documentation

If you wish to send an attachment (photos, estimates, or claim documentation) with your message, please submit the form, then email the attachment directly to us at motorclaimsireland@aviva.com

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