Total-Loss / Write-Off Vehicle Dispute Questionnaire
Form Account (optional)
New Users / Returning Users
CLICK HERE
to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.
1. Your Name:
2. Your e-mail address:
3. Your Telephone number:
4. Your postcode:
5. How much did you pay for the vehicle?
6. Where did you see the vehicle advertised for sale?
Auto Trader
Exchange & Mart
Ebay
A dealer’s forecourt
Internet trader
Auction
In the window of the car
Word of mouth
From a friend
Other:
7. Are you still in possession of the vehicle?
Yes
No
8. On the day you purchased the vehicle what registration number was displayed:
9. Do you believe the registration mark displayed at purchase was correct for the vehicle
No
Yes
I do not know yet
10. If the registration mark displayed at purchase was false, what is the correct registration mark:
11. On what date did the purchase occur:
12. At what address did the purchase occur. Please try to be as specific as possible (note - the postcode is requested in the next question):
13. What is the postcode for the address at which the purchase occured:
14. What was the name of (or used by) the person who sold you the vehicle?
15. 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?
16. What was the address of the person who sold you the vehicle (note – the next field asks for the postcode. If this address is the same as at question '12' (above), please enter 'as 12':
17. What is the postcode for the address of the person who sold you the vehicle. If this is as at 12, please still enter the information:
18. What was the mobile telephone number of the person who sold you the vehicle
19. What was the home or work (land line) telephone number of the person who sold you the vehicle
20. Do you have any reason to believe that the person who sold you the vehicle gave a false name?
Yes
No
I do not know
21. Please advise with which company you undertook a pre-purchase enquiry of the vehicle:
None
MyCarCheck
Experian / Motorfile
HPI
AA Car Data Check
RAC
Auto Trader
Other:
22. 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:
23. Please use this part of the form to provide us a little more information about what happened to cause you to be in this situation:
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 24 hours, providing documentation.