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Book an Appointment
↓
Vehicle/Property Release
Transport Release
About
Services
Coverage
Careers
Compliance
Submit a Claim
Contact
Claims Form
Claimant
Required
What type of claim is this?
Select One...
Damage to vehicle - Cosmetic
Damage to vehicle - Mechanical
Damage to personal property
Missing personal property
Other
Registered owner of vehicle
Required
Vehicle Year
Vehicle Make
Vehicle Model
Vehicle Vin
Required
Street Address
Address Line 2
City
State
Zip
Best contact phone number
Email
Date of Statement
Date of Repossession
What time did it occur?
Did you witness the repossession take place?
No
Yes
Did you see the damage done? If yes, Describe the circumstances related to the damage occurring.
Did you speak to the repossessor?
No
Yes
Did you surrender the keys to the vehicle?
No
Yes
Can you describe the equipment used to repossess the vehicle?
Was the vehicle towed from the front or the rear?
Rear
Front
Was the vehicle parked rear end in or head in?
Rear end in
Front end in
Describe the weather at that time?
Where was the vehicle parked at the time of repossession?
Has the vehicle been previously involved in any accident?
If yes. When?
Describe any previous damage.
Who was the last person to drive the vehicle?
Before discovering the damage, when was the last time you saw the car?
Date & Time last seen
Was the car locked last time you saw it
No
Yes
If yes, did you park the car where it was repossessed from?
Where did you redeem your vehicle?
Date & Time Redeemed
Please describe the damage in detail.
Was there any aftermarket equipment installed on the vehicle?
Was there a police report made?
No
Yes
If yes, provide the Police contact information, report number and officers name.
Have you obtained an estimate for the alleged damages?
No
Yes
If yes, attach a copy.
Drag file here
Drop file to upload
Are there any pictures available of the vehicle or the incident?
No
Yes
If yes, attach a copy.
Drag file here
Drop file to upload
Are you aware of any video of the incident?
No
Yes
If yes, attach below. Or if too large please submit video clips to claims@narsrepo.com and put the date of the incident, Vin number if any in the subject line, reference your name in the email. (videofile)
Were there any witnesses to this claim?
No
Yes
If yes, Please provide us with name and contact information.
What proof do you have to show that the damage wasn’t there before the vehicle was repossessed?
Attach supporting documents.
Drag file here
Drop file to upload
Do you have full coverage insurance on the vehicle?
No
Yes
If yes, what company and policy number?
Please list all items that you are claiming as damaged and their estimated value at the time of the loss (factor in estimated wear and tear).
I understand that my signature below certifies, under penalty of perjury, that the information submitted by me is true and correct.
I understand that my signature below certifies, under penalty of perjury, that the information submitted by me is true and correct.
I understand that any false or misleading information submitted by me will result in a denial of this claim and possible criminal prosecution, under state law for insurance fraud.
I understand that any false or misleading information submitted by me will result in a denial of this claim and possible criminal prosecution, under state law for insurance fraud.
Attach a legible copy of your State issued identification or your claim will not be considered. Your failure to cooperate will result in a denial of your claim.
Attach a legible copy of your State issued identification or your claim will not be considered. Your failure to cooperate will result in a denial of your claim.
Your cooperation with the claims handler during our investigation is necessary to properly evaluate your claim. Your lack of cooperation may result in a denial of your claim.
Your cooperation with the claims handler during our investigation is necessary to properly evaluate your claim. Your lack of cooperation may result in a denial of your claim.
Our investigation, which may consist of, but not limited to, interviewing witnesses and individuals who may have any knowledge of the issues described by you.
Our investigation, which may consist of, but not limited to, interviewing witnesses and individuals who may have any knowledge of the issues described by you.
By electronically executing this claim form, I am declaring, under penalty of perjury, that the information contained herein is true and correct.
By electronically executing this claim form, I am declaring, under penalty of perjury, that the information contained herein is true and correct.
I understand that my signature below certifies, under penalty of perjury, that the information submitted by me is true and correct.
I understand that my signature below certifies, under penalty of perjury, that the information submitted by me is true and correct.
Signature
Required
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