Warranty First Repairs – Repairer's Assessment Form

All fields are required to be completed accurately; any information that is not correct could delay or prevent a decision being made on a claim.

Policy Holder Details

Repairing Garage Details

Vehicle Details

Parts Required

Policy Holder Details

Please complete the Policy Holder’s details below.

Name

Contact number

Vehicle registration number

Repairing Garage Details

Please complete the Repairing Garage’s details below.

Business name

Business Address

Business Postcode

Contact number

Contact name

Business email

VAT number

Vehicle Details

Please complete the Vehicle Details details below.

Current accurate mileage

Fault date

Symptoms

Cause of failure

Labour rate (exc VAT) per hour

Parts Required

Please complete the Parts Required details below.

Part name (Please specify NS/OS/front/rear etc, if applicable)

Part number

Part price (net VAT)

Quantity required

Labour time (hours)

Sub-total

Total Cost:

£ (exc VAT)

Total Cost:

£ (incl VAT)

Submit Assessment Form

Assessment Form Requirements

I understand that all repairs must be completed by a VAT registered garage and that no repairs will be progressed prior to authorisation being received from Warranty First. Any work carried out prior to authorisation being received could prevent an authorisation being issued. Completing this form in no way guarantees any authorisation or payment from Warranty First.

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Repairer's Assessment Form

Policy Holder Details

Repairing Garage Details

Vehicle Details

Parts Required

Total Cost:

Total Cost:

Submit Assessment Form

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