Cover · free template

Auto Insurance Claim

Two-page motor claim: vehicle and policy details, how the collision happened, damage and drivability, other drivers, witnesses and police reference.

A ready-to-use insurance form for small teams who need a reliable intake process: 27 questions, 2 pages, 4 conditional rules.

Questions
27
Pages
2
Layouts
classic · card
Time to complete
≈ 7 min
Conditional rules
4
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Live preview and test console

This is the real form. Answer it to test the flow — nothing is sent or stored.

Page 1 of 2 — Policy and vehicle

Your policy and vehicle

Include your country code.

Was the driver a named driver on the policy?

This template runs as a straight sequence — no branching rules.

Compliance checklist

Ready to publish
  • Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
  • Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
  • Financial disclaimer present — passingThis form does not provide financial, tax or legal advice. Any figures shown are indicative only and are not an offer of credit or a guarantee of terms. Please seek advice from a regulated adviser before making a decision.
  • Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

Auto Insurance Claim is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

  • Small teams who need a reliable intake process working in insurance.
  • Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
  • Anyone replacing chasing missing details over email with one structured record per enquiry.
  • Respondents are the people you send it to — the form asks them 27 questions across 2 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

  • 18 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It collects a verified email address so replies and confirmations land.
  • It captures a phone number for urgent follow-up.
  • It accepts a document or photo upload as evidence.
  • It pins the request to a specific date.
  • It allows multiple selections without free text.
  • It captures a numeric value you can filter and sort on.
  • Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Auto Insurance Claim lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Check the upload limits on the file question so respondents can attach what you actually need.
  5. 5Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  6. 6Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

  • Features conditional validation: if “Was the driver a named driver on the policy?” is No, “Who was driving, and why were they using the vehicle?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Is the vehicle drivable?” is No, “Where is the vehicle now?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Was anyone injured?” is Yes, “Who was injured, and were they treated?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Did the police attend?” is Yes, “Police reference number” becomes mandatory before the form can be sent.
  • All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

A motor claim is decided largely by details captured in the first day: which vehicle, who was driving, where the impact landed and whether the car still moves. This two-page form collects them in that order. The first page covers the policy and the vehicle — policy number, policyholder, registration, make, model and year, who was driving at the time and whether they are named on the policy, which is the answer that most often changes how a claim is handled. The second page covers the incident itself: date, time and location, road and weather conditions, what happened in the driver's words, the impact point on the vehicle, whether it is drivable, whether anyone was injured, and the other vehicle's registration, driver and insurer. Police attendance and any reference number are recorded, along with witnesses, dashcam footage and photographs. Nothing here says what a policy covers or what will be paid; cover depends on the policy wording and the insurer's own assessment, and the form is the notification that starts it.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — Policy and vehicle

  • Policy numberrequired
  • Policyholder namerequired
  • Contact numberrequired
  • Email addressrequired
  • Vehicle registrationrequired
  • Make and modelrequired
  • Year of manufacture
  • Was the driver a named driver on the policy?required
  • Who was driving, and why were they using the vehicle?
  • Approximate mileage

Page 2 — What happened

  • Date of the incidentrequired
  • Time of the incidentrequired
  • Where did it happen?required
  • What were the conditions?required
  • Describe what happened in your own wordsrequired
  • Where did the impact land on your vehicle?required
  • What damage can you see?required
  • Is the vehicle drivable?required
  • Where is the vehicle now?
  • Was anyone injured?required
  • Who was injured, and were they treated?
  • Other vehicle registration, driver name and insurer
  • Did the police attend?required
  • Police reference number
  • Do you have dashcam footage?required
  • Witness names and contact details
  • Upload photos of the damage and the scene

27 questions in total.

Example of a completed auto insurance claim form

This sample shows how a policyholder reports a collision when making a claim.

Policyholder name
Samuel Odera
Vehicle registration
BF19 XLM
Make and model
Toyota Corolla
Date of the incident
18 May 2026
Where did it happen?
Junction of Park Road and Vine Street
Describe what happened in your own words
The other driver pulled out of a side road without stopping and struck my front wing.
What damage can you see?
Dented front wing and a cracked headlight
Was anyone injured?
No
Did the police attend?
No

Sample data — no real people, addresses or records are shown.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 4 behaviours driven by 4 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Was the driver a named driver on the policy?”

  • Makes answers required

    If “Was the driver a named driver on the policy?” is No, “Who was driving, and why were they using the vehicle?” becomes required before the form can be submitted.

Driven by “Is the vehicle drivable?”

  • Makes answers required

    If “Is the vehicle drivable?” is No, “Where is the vehicle now?” becomes required before the form can be submitted.

Driven by “Was anyone injured?”

  • Makes answers required

    If “Was anyone injured?” is Yes, “Who was injured, and were they treated?” becomes required before the form can be submitted.

Driven by “Did the police attend?”

  • Makes answers required

    If “Did the police attend?” is Yes, “Police reference number” becomes required before the form can be submitted.

Set it up step by step

  1. 1

    Ask for the impact point as tick boxes

    Where the damage sits is the fastest sanity check a handler has against the written account, and checkboxes make it comparable across claims.

  2. 2

    Split drivable from damage

    A drivable answer decides whether recovery is arranged today, so keep it as its own question rather than reading it out of a description.

  3. 3

    Collect the police reference immediately

    It becomes hard to obtain after a few weeks, and the conditional field means only the claims that have one are asked.

  4. 4

    Invite photos while they exist

    Phone photos get deleted; the upload field at the end of the incident page is where most usable evidence arrives.

Mistakes to avoid

  • Promising an outcome or a settlement timescale in the form's copy.
  • Asking for a single accident description and no structured impact or drivability answer, which slows every handler down.
  • Skipping the named-driver question, which changes how the claim is assessed and is awkward to ask later.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Acknowledge with a claim reference, arrange recovery for any vehicle that is not drivable, and request statements from named witnesses with the Claim Witness Statement.

Works in both layouts

Browse classic templatesBrowse card templates

Forms that overlap this one

These pages cover the same subject ground as the auto insurance claim, matched on the words people actually search for.

Frequently asked questions

How is this different from the general claim submission?

Insurance Claim Submission works for any policy type. This one carries the motor-specific fields — registration, make and model, driver, impact point, drivability and the other vehicle.

Does submitting it mean the claim is accepted?

No. It is a notification. Whether anything is payable depends on the policy wording and the insurer's assessment, and the form does not decide either.

Should the form ask who was at fault?

It asks what happened instead. Fault is an assessment, and a form that asks for it tends to collect an argument rather than the facts a handler needs.

What if the policyholder was not driving?

Answer no to the named-driver question and the form asks who was driving and why, which is exactly the detail a handler would otherwise chase.

Is the Auto Insurance Claim template free to use?

Yes. You can preview and test Auto Insurance Claim on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Auto Insurance Claim template ask for?

It asks 27 questions across 2 pages, 18 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Auto Insurance Claim form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this insurance form work?

4 conditional rules ship with the template: Features conditional validation: if “Was the driver a named driver on the policy?” is No, “Who was driving, and why were they using the vehicle?” becomes mandatory before the form can be sent. Features conditional validation: if “Is the vehicle drivable?” is No, “Where is the vehicle now?” becomes mandatory before the form can be sent. Features conditional validation: if “Was anyone injured?” is Yes, “Who was injured, and were they treated?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Auto Insurance Claim form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Auto Insurance Claim form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

Can respondents upload files?

Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.

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