Salutation : * Mr. Mrs. Ms. Dr. Prof.

Vehicle User Name :*
 

Designation :*
 

Client / Company Name :*
 

PIN :*
 

Ph. No :*
 

Mobile No :*
 

E-Mail :*
 

Reg. Number :*
 

Make & Model :*
 

Current KM :*
 

Chassis Number :*
 

Engine Number :*
 

Insurance Company Name :*
 

Policy No :*
 

Policy End Date :*
 

Name :*
 

Address :*
 

PIN :*
 

Date of Birth :*
 

Licence Number :*
 

Place and date of issue :*
 

Licence Expiry Date :*
 

Accident Date : *
 

Time : *
 

Location :*
 

Narration *:
 

Purpose of the vehicle being used at the time of accident : *
 

Details of Police Station *:
 

Phone No :*
 

First Information Report number (If Applicable):


First Information Report (FIR) should be lodged with Police, in case of third party injury or damage to third party property. FIR copy should be attached along with a separate sheet giving complete Third Party Driver , Vehicle & Insurance details and sent to Arval:
- By fax number: +91-022-67087719
- By e-mail e-mail (scanned documents) to service@arval.in
We declare that the above information is accurate & correct to the best of our knowledge and we will be liable for any losses, in case any of the information provided above is found to be incorrect.

Note : Please don’t leave any valuables behind in the vehicle. Please remove all removable accessories from the vehicle before handing it over to the workshop (e.g. Stereo system face), Arval India shall not be responsible for loss of any valuables.