Repairer's Assessment Form

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Holder
2
Repairer
3
Vehicle
4
Parts
5
Cost

Plan Holder Details

Please complete the Plan Holder's details below.

If your repair request is for the vehicle's Engine, Gearbox, Turbo, ABS, Transfer Box, or Differential, we will need to see the vehicle's Service History to progress your request. If the Service History is not provided, we cannot progress further with the assessment which will result in a delay actioning your request.

Plan Reference:*

Plan Holder's Name:*

Contact Number:*

Vehicle Registration:*

Vehicle Make:*

Vehicle Model:*

Repairer Details

Please complete the repairer's details below.

Company Name:*

Contact Name:*

Address:*

Postcode:*

Telephone Number:*

Repairer Fax:

Repairer Email:*

VAT Number:*

Repair Details

Please complete the fields below in order to continue.

Vehicle Mileage:*

VIN Number:*

Date of Breakdown:*

Hourly Labour Rate (exc VAT):*

Symptoms:*

Reason For Failure:*

Parts Required

Please complete the fields below in order to continue.

Part Name	Part Number	Price	Qty	Labour Time (Hours)

Costs

Please complete the fields below in order to continue.

Recovery (exc VAT):*

Car Hire (exc VAT):*

Diagnostics (exc VAT):*

Invoice Total (exc VAT):*

Additional Notes:

Assessment Form Requirements

Please take your instructions from the vehicle owner regarding authorisation to confirm the payment of your invoice. Do not complete any repairs until Warrantywise have decided whether (or not) an independent inspection is required and issued authorisation. Fraud is a serious crime and anyone attempting to make a fraudulent request will be prosecuted.

This request for repair is made by the vehicle owner, subject to Warrantywise plan limits, exclusions and terms and conditions. The completion of this form does not guarantee authorisation or any payment from Warrantywise. However, failure to complete and submit this form will result in any decision being delayed.

Please tick to confirm the information you have provided is accurate and that you have understood and followed the Assessment Form Requirements shown above.

Thank You

Thank you for submitting your repair form. We have now received a copy of the form and will be in touch shortly. If you have a question regarding the repair, please contact us on 01254 355 102 and we will be happy to help.

Vehicle Owner / Plan Holder

Please ask your chosen VAT repairer to fully complete this form.

VAT Registered Repairer

Please take your instructions from the vehicle owner regarding authorisation for the stripdown and to confirm the payment.
Do not complete any repairs until Warrantywise have decided whether (or not) an inspection is required and issues authorisation.
This request for repair(s) is made by the vehicle owner, subject to Warrantywise repair limits, exclusions and terms and conditions.
The completion of this form does not guarantee authorisation or any payment from Warrantywise.
Failure to fully complete and return this form will result in this repair being delayed.