Plan Holder Details

Please complete the Plan Holder's details below.

Please specify the plan holder's reference number.
Please specify the plan holder's name.
Please specify the plan holder's contact number.
Please specify the vehicle registration number for the requested repair.
Please specify the make of the vehicle.
Please specify the model of the vehicle.
Repairer Details

Please complete the repairer's details below.

Please specify the repairer's company name.
Please specify the name of the repairer.
Please specify the address of where the repair will take place.
Please specify the postcode of where the repair will take place.
Please specify the telephone number of the repairer or company where the repair will take place.
(Optional) please specify the fax number of the repairer or company where the repair will take place.
Please specify the email address of the repairer or company where the repair will take place. We will use your email to send you a confirmation of the repair submission.
Please specify the VAT number of the repairer or company where the repair will take place.
Repair Details

Please complete the fields below in order to continue.

Please specify the mileage of the vehicle.
Please specify the VIN number of the vehicle.
Please specify the date when the vehicle broke down.
Please specify the repairer's labour rate.
Please describe the symptoms of the vehicle.
Please describe the reason for the vehicle failing.
Parts Required

Please complete the fields below in order to continue.

Part Name Part Number Price Qty Labour Time
Costs

Please complete the fields below in order to continue.

Please specify the cost of recovery. Enter 0 if not applicable.
Please specify the cost of car hire. Enter 0 if not applicable.
Please specify the cost of diagnostics. Enter 0 if not applicable.
Please specify the invoice total. Enter 0 if not applicable.
Please enter any additional notes about this repair.
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 Warrantyiwse.
  • Failure to fully complete and return this form will result in this repair being delayed.