Motor Claim

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

Date of Incident

E.g., 25-11-2024

Time of Incident

E.g., 07:30

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 types: jpg jpeg gif png bmp heic.
Allowed types: jpg jpeg gif png txt doc xls pdf ppt pps odt ods odp.

Allowed types: jpg, jpeg, gif, png, bmp, heic.

CAPTCHA

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