Register Motor Claim | Gulf General Cooperative Insurance Company

Motor Claim Registration

Accident surveyed by *

Accident report number Basher/Muroor Accident report number *

Third Party Sequence Number Sequence Number Insured Vehicle Sequence Number *

GGI Insured Vehicle Sequence Number

Accident Date

In accordance with the rules for collecting and exchanging insurance information for vehicles, I agree to grant the insurance company the right to receive, disclose and exchange insurance information with Najm Insurance Services Company and the National Information Center regarding the submitted insurance claim or previous claims in order to obtain the insurance record

Claimant Details Insured Details

Policy Number

Insured Name

Driver National Id

Owner national id

Contact mobile number *

Vehicle Make

Vehicle Model

Vehicle Plate Number EN

Vehicle Plate Number AR

Manufactured Year

Claimant Name

Driver National Id

Owner national id

Contact mobile number *

Vehicle Make

Vehicle Model

Manufactured Year

Estimation Details

Do you have Taqdeer Reference Number? Yes No

Taqdeer Reference Number *

Taqdeer No

Estimation Amt. *

Do you have Taqdeer Bill? Yes No

Amt. *

Do you have Towing Bill? Yes No

Amt. *

IBAN Details

I hereby certify that the information provided is true and accurate. I also understand that any willful dishonesty may be grounds for immediate rejection and/or penalties as specified by Law.

As per regulation the only beneficiary is the vehicle owner, If you are the vehicle owner please fill the IBAN number of vehicle owner, if you are not you need to provide us with attested authorization letter or power of attorney from vehicle owner. Gulf General insurance Company will check and validate the IBAN number and has the authority to hold/reject the claim if the IBAN number does not belong to the vehicle owner.

Yes No

Please select one of the following:

Id of Account *

IBAN No *

Bank Name *

Bank Account Name EN

Bank Account Name AR

Accident Details

Accident Date *

Accident City *

Liability *

GGI Insured Driver Fault/ Liability *

Accident Type *

Accident Description

Motor Claim Registration

Dear Client,

Dear Claiment,

Claimant Details Insured Details

Estimation Details

IBAN Details

Accident Details

Claim Documents*Mandatory Document