Report an Accident

Please complete the form below to report an accident in a Green Motion vehicle.

It is important to spend time completing this form with as much information as possible.   Even if you have reported the accident by telephone to us.

For the purposes of this report we define an accident as your vehicle coming into contact with another vehicle or a person.   
 
If your car has been damaged such as a stone chip, a puncture or a bodywork scrape then still continue  to complete the form.  It will be much quicker in those circumstances.
You will need your rental agreement with you when you complete this form.

I confirm that the facts stated in this claim form will be true and correct.

Registration Number of Green Motion vehicle (required)

Rental Agreement Number (required)

Driver at time of incident (required)

Email address (required)

Mobile (Cell) phone number (required)

Are you reporting an accident or new damage?
AccidentDamage

Please describe the damage to the rental car.

Is the vehicle still drivable?
YesNo

Is the vehicle still in your possession?
YesNo

Where is the vehicle?

Please upload any photographs of the scene or vehicle.

If you have more photographs please email them to adam.haworth@greenmotion.co.uk

At the time of the accident how many people where in the Green Motion vehicle?

Were any other vehicles involved?

Vehicle 1

Vehicle 2

Vehicle 3 and others

Was anybody injured?

How many people were injured?

Injury 1

Injury 2

Injury 3

Injury 4

Were there any witnesses?

Please provide details of the accident:

What was the date & time of the incident?

Where did the incident happen?

What were the road conditions?

What was your speed in MPH?

What was the speed of the other vehicle in MPH?

What was the width of the road in metres?

Were your car lights on?

Were the other vehicles lights on?

What was the visibility like?

Were the street lights on?

Did the Police attend?

Officers name and number

Which Police station?

Did you make a written statement?

Was anyone cautioned or arrested by the Police?

Who?

Did the Vehicle & Operator Services Agency (VOSA) attend?

Please describe the circumstances of the situation.

Who do you blame for the incident and why?

Signed