Motor Trade Incident Notification Form Please enable JavaScript in your browser to complete this form.Policyholder Name *Policy Number *Policyholder Contact Number *Policyholder Email AddressPolicyholder Postal Address *Include if differs from Risk AddressPolicyholder Communication PreferenceTell us who would like to be kept informed of the claim, and how (phone/Email)Details of Any Representative Appointed by the PolicyholderIf a solicitor or Public Loss assessor has been appointed please provide details here, including contact detailsBroker Email Address: *Note: A copy of the form will be sent to this address.Broker Contact Number *Who Was Driving the Vehicle at the Time of the Incident? *What Was the Purpose of the Journey? *Who Owns the Vehicle? *If You Are Not the Owner of the Vehicle, Why Was It in Your Custody or Control at the Time of the Incident? *Incident Details *Incident Location *Please include Eircode, if aware.Third Party Name (If Third Party Involved)Third Party Contact detailsPlease record here if the Third Party is known to the Policyholdere.g. Employee of PolicyholderSubmit