Motorcycle Insurance Claim
Motorcycle Insurance Claim
Date: [Date]
Policyholder Information
|
Name |
[Your Name] |
|
Policy Number |
[Policy Number] |
|
Email Address |
[Your Email] |
Incident Details
|
Date of Incident |
July 15, 2024 |
|
Time of Incident |
3:45 PM |
|
Location of Incident |
123 Main Street, Cityville, ST 12345 |
|
Description of Incident |
The motorcycle was involved in a collision with another vehicle while making a left turn at an intersection. The other vehicle was at fault. |
|
Police Report Number |
PR1234567890 |
|
Police Department |
Cityville Police Department |
Motorcycle Information
|
Make |
[Motorcycle Make] |
|
Model |
[Motorcycle Model] |
|
Year |
[Motorcycle Year] |
|
VIN |
[Vehicle Identification Number] |
Damage Details
The following is a detailed list of the damages sustained by the motorcycle:
-
Front-wheel: Bent
-
Front fairing: Cracked
-
Right-side footpeg: Broken
-
Handlebars: Scratched
Estimated Repair Costs
|
Component |
Repair Cost |
|---|---|
|
Front-wheel |
$300 |
|
Front fairing |
$500 |
|
Right-side footpeg |
$100 |
|
Handlebars |
$200 |
|
Total Estimated Repair Costs |
$1,100 |
Additional Notes
-
The motorcycle was towed to the repair shop immediately after the incident.
-
I am requesting expedited processing of this claim due to the urgent need for repairs to resume normal use of the motorcycle.
Attachments
-
Photos of damaged motorcycle
-
Repair estimate from Auto Repair Shop
-
Police report
Policy Holder Statement
I certify that the information provided in this claim is true and accurate to the best of my knowledge. I understand that any misrepresentation or falsification may result in the denial of this claim.
[Your Name]
