Claim Form Making a claim We understand that it can be very stressful if you need to make a claim. Our claims team are here to help guide you through the process and assist you when you need it most. 1Your details2Incident details3Witnesses and police report Policy numberName of insured personPostcodePreferred contact numberEmailPreferred method of contactEmailPhone Type of incidentI had a crashA 3rd party was involvedI got injuredMy bike got stolenOtherBike make and modelSerial number of bikeDate and Time of incident0:001:002:003:004:005:006:007:008:009:0010:0011:0012:0013:0014:0015:0016:0017:0018:0019:0020:0021:0022:0023:0024:00Where did the incident occur?Please describe what happenedWhere is the bike now?3rd Party DetailsHow were they involved?Name of person involvedContact Number (if known)Registration numberName of their insurerApplicable claim numberInjuriesWhat injuries did you sustain in the accident?Supporting EvidencePlease upload any appropriate photographs, documents or any other evidence which may be relevant to your claim. For example, any evidence of injuries sustained, damage to your bicycle, damage to any locks or forced entry, witness statements, etc. Briefly describe the evidence attached above Witness nameWitness contact numberPolice ReportPolice stationPolice report numberDate and Time reported0:001:002:003:004:005:006:007:008:009:0010:0011:0012:0013:0014:0015:0016:0017:0018:0019:0020:0021:0022:0023:0024:00Other InsuranceDo you have other insurance like home and Contents?YesNoIf yes, please provide details Please Wait Declaration x I hereby certify that the information given in the form is truthful, accurate and complete. No information likely to affect this claim has been withheld. I understand that this claim may be refused if information is untrue, inaccurate and concealed. I authorise RealBike to give to, or obtain from other insurers or any insurance reference bureau, any information relevant to this claim or any other claim made by me on any insurance policy held by me.