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Vehicle Check Claim Registration
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1. Your Name:
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2. Your e-mail address:
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3. Your Telephone number:
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4. Your home address:
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5. Your postcode:
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6. What has caused you to submit this claim?
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I believe the vehicle I acquired is stolen.
I believe the vehicle I acquired was previously written off.
I believe the vehicle I acquired has finance outstanding.
I believe the vehicle I acquired was taken from another by fraud.
Other, please advise:
Other, please advise:
7a. On the day you purchased the vehicle what registration number was displayed:
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7b. What is the current registration number displayed on the vehicle
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7c. What is the make and model of the vehicle:
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8. Do you believe the registration mark displayed at purchase was correct for the vehicle
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No
Yes
I do not know yet
9. If the registration mark displayed at purchase was false, what is the correct registration mark:
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10. Where was the vehicle advertised for sale?
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RAC Cars
Gumtree
Auto Trader
Exchange & Mart
Ebay
A dealer’s forecourt
Internet trader
Auction
In the window of the car
Word of mouth
From a friend, relative or family member
Other:
Other:
11. Are you a:
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Motor Trader
Private buyer
12a. How much did you actually pay for the vehicle?
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12b. Was a part-exchange involved
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Yes
No
12c. If a part exchange was involved, what the registration mark of that vehicle upon which you enquired, the subject of this submission?
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13. Are you still in possession of the vehicle?
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Yes
No
14a. With which agency did you check the vehicle:
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MyCarCheck
RAC
MotorSpecs / Motorcheck.ie
Other:
Other:
14a. On what date did you undertake your enquiry of the vehicle:
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15. On what date did the purchase occur:
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16. What was the name of (or used by) the person who sold you the vehicle?
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17. Do you have any reason to believe that the person who sold you the vehicle gave a false name?
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Yes
No
I do not know
18. What was the residential address of the person who sold you the vehicle. Note – the next field asks for the postcode.
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19. What is the postcode for the address of the person who sold you the vehicle.
20. At what address did the purchase occur. Please try to be as specific as possible (note - the postcode is requested in the next question):
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21. What is the postcode for the address at which the purchase occured:
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22. If the person that sold you the vehicle was a trader or a company, what company name did they use or appears on their invoice?
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23. What is the business address used by the vendor or appearing on their invoice. Note – the next field asks for the postcode.
24. What is the postcode for the vendor's business address:
25. What was the home (land line) telephone number of the person who sold you the vehicle
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26. What was the work (land line) telephone number of the person who sold you the vehicle
27. What was the mobile telephone number of the person who sold you the vehicle
28. With regard to the Police, please provide, if known, the name, ‘collar number’, station, address and reference for the officer dealing with the investigation. If the matter has not yet been reported to the police, please enter ‘none yet’ in the field below:
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29. What is the e-mail address of the police officer? NOTE: if you do not possess this, please obtain and supply it:
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30. Please use this part of the form to provide us more information about what happened to cause you to be in this situation. The more detail you provide the more specific our enquiries can be, the more we can do to assist and the quicker we can address the claim:
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Thank you for taking the time to complete this form. By clicking on the submit button below the information you have provided will be sent to us and we will return to you within the next 2 working days.
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