File a Claim – Defender Vehicle Protection

Claim Form

Step 1 of 4

Step 1 - Contact Information
Customer Name*
First Last
Address*
Street Address Address Line 2 City State Zip Code
Phone*
Email*
Enter Email Confirm Email

Step 2 - Vehicle Information
Year*
Make*
Model*
VIN #*
Selling Dealership*
Warranty Registration Number*
When was vehicle purchased?*
MM slash DD slash YYYY

Step 3 - Claim Description Information
Select Claim Type*
Paint Damage
Examples of Pant Damage

Hard Water Etching

Bug Etching

Bird Dropping Etching
Date Damage Was Noticed*
MM slash DD slash YYYY
Size of Damage*
Description of Damage*
Damage Location*
Cause of Damage*
Methods to Remedy Damage
Dent Damage
Examples of Windshield Damage

Large Dent

Dent with no paint damage
Date Damage Was Noticed*
MM slash DD slash YYYY
Size of Damage*
Description of Damage*
Damage Location*
Cause of Damage*
Methods to Remedy Damage
Alloy Wheel Damage
Examples of Alloy Wheel Damage

Corrosion

Scratched Wheel

Scuffed Wheel
Date Damage Was Noticed*
MM slash DD slash YYYY
Size of Damage*
Description of Damage*
Damage Location*
Cause of Damage*
Methods to Remedy Damage
Headlight Damage
Examples of Headlight Damage

Fogged Headlight
Date Damage Was Noticed*
MM slash DD slash YYYY
Description of Damage*
Damage Location*
Cause of Damage*
Methods to Remedy Damage
Windshield Damage
Examples of Windshield Damage

Bullseye

Combination

Crack

Half Moon

Star Break
Date Damage Was Noticed*
MM slash DD slash YYYY
Size of Damage*
Description of Damage*
Damage Location*
Cause of Damage*
Methods to Remedy Damage
Carpet Damage
Examples of Carpet Damage

Carpet Strain
Date Damage Was Noticed*
MM slash DD slash YYYY
Size of Damage*
Description of Damage*
Damage Location*
Cause of Damage*
Methods to Remedy Damage
Upholstery Damage
Examples of Upholstery Damage

Burn

Fabric Stain

Leather Stain

Rip

UV Damage
Date Damage Was Noticed*
MM slash DD slash YYYY
Size of Damage*
Description of Damage*
Damage Location*
Cause of Damage*
Methods to Remedy Damage
Photos
Upload Photos of Damage (Max 6 Photos)
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB, Max. files: 6.

Step 4 - Acceptance and Submission
Please read the following statements carefully, as a claim will not be processed unless initials from the claimant / service advisor have been provided.

Please type your initials to indicate: I am aware that ******* relies on the information and statements above. I hereby certify that the above statements are complete and accurate to the best of my knowledge. I understand that any inaccurate information entered on this form could affect the outcome of the claim, including denial of claim.
Your Initials*

Claim Form

Step 1 of 4

Step 1 - Contact Information

Step 2 - Vehicle Information

Step 3 - Claim Description Information

Paint Damage

Dent Damage

Alloy Wheel Damage

Headlight Damage

Windshield Damage

Carpet Damage

Upholstery Damage

Photos

Step 4 - Acceptance and Submission