Purchase and sale history
If somebody was due to purchase it please provide their name, address and any contact Specifications & modifications
How many speeds does your manual transmission have?
How many speeds does your manual transmission have? 1 2 3 4 5 6
Did your vehicle have:
Colour when stolen (detailed)
Colour changes made by present owner
Details of the wheel assemblies (i.e. colour/identifying features/mags/standard)
Interior trim (i.e. colour/material/type, include seats/door panels and dashboard)
Accessories & identifiable contents:
Please list the accessories
Condition poor average good near new Remove
Please list identifiable contents General condition & service history
Service & repair history:
Please attach documentation in the Photos & documents section
Warrant/Certificate of Fitness:
What was the condition of the following:
Please describe the condition of the following:
Body (i.e. rust or poor repairs)
Paintwork (i.e. faded or patchy)
Pursuant to the Privacy Act 2020
To be completed by the Insured(s) shown and also on behalf of any other person covered by these insurances.
For policies issued before 1st July 2022 or renewed before 1st August 2022, your insurer is Vero. For all other policies your insurer is Berkshire Hathaway Specialty Insurance Company.
Declare to the best of my/our knowledge and belief all information given to Star Insurance Limited (Star) who acts as agent for the insurer and/or any other party(ies) authorised by Star or the insurer to receive information from me in connection with this claim (whether this information is supplied orally or is written) is complete, true and correct and no information relevant to the claim is omitted. Agree to provide any further information that may be required by Star, the insurer or any other party(ies) authorised by Star or the insurer to receive information and/or to process this claim.
Authorise the disclosure of this information to other parties, including parties with a financial interest, private investigators, crown authorities, advisors, repairers or parties involved in replacing the subject matter of this claim.
Authorise the obtaining personal information about me/us that is in Star and/or the insurer and/or any other party(ies) authorised by Star and/or the insurer to process this claim view as relevant to this claim.
Understand that I am/we are entitled to have certain rights of access to and correction of the personal information held by Star and/or the insurer and/or any other party(ies) authorised by Star and/or the insurer to process this claim.
The following additional conditions only apply where Vero is the named insurer on your policy:
Authorise the obtaining of personal information in any way relevant to this claim from Insurance Claims Register Ltd (ICR).
Authorise Star/Vero to place details of this claim on the database of ICR where it will be held and made available for other insurance companies to inspect The information in this claim is complete, true and correct and no information relevant to the claim is omitted