Motor Claim | RSA Ireland Insurance

RSA or 123? *

What is your role in this claim notification? *

Based on whether you are the Policyholder, named/covered under the policy or are a third party, different questions may apply

Broker/Bank/Intermediary name

Name (of Policyholder) *

Your Name

RSA/123 Policy number *

Your Insurer

Your Policy Number

Postal Address of Policyholder

Your Email address *

Your Phone number *

RSA/123 Policyholder Vehicle Registration *

RSA/123 Policyholder Vehicle Make and Model *

Your Vehicle Registration

Your Vehicle Make and Model

Location of incident *

Driver of the RSA/123 Policyholder’s vehicle? *

Driver of your vehicle

Incident circumstances *

Were any pedestrians or cyclists involved? *

How many vehicles were involved (including your car)? *

How many passengers were in the Policyholders vehicle? *

How many passengers were in the other vehicles? *

Was anyone injured? *

Injury details

Did the Gardai or Fire Brigade or Ambulance services attend at the scene?

Is your vehicle driveable since the incident? *

Where is your vehicle now? *

Who do you believe was at fault for the incident? *

Name and contact details of other involved parties

Image attachments to be submitted

Allowed file types: jpg jpeg gif png bmp heic.

Math question (captcha) * 4 + 0 =

To prove you are not a robot, solve this simple math problem and enter the result

You can read our full Data Protection Notice here. Please indicate that you have read and understood this Notice. *

This data once submitted, cannot be directly amended by you at a later point. An RSA/123 Claims handler will be in contact to discuss your claims notification, as per the inputs you have supplied.