Book Online Company: Authorised by: Tel. Number: Claim E-mail: Claims Handler: Date: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August Septemebr October November December 2008 2009 2010 2011 2012 2013 2014 Insured: Name: Driver: Contact Number: Policy No: Claim Number: Date of Loss: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2008 2009 2010 2011 2012 2013 2014 Type of Insident: Theft Write-off Accident Insurer: ONLINE BOOKINGS Rental: Car Group: L - Opel Corsa Lite (or similar) - Manual 1.1 / 1.3 / 1.4lt O - VW Chico Golf - Manual 1.4lt A - VW City Golf - Manual 1.4lt B - Ford Fiesta (or similar) - Manual 1.4lt R - Fiat Grande Punto - Manual 1.4lt B+ - Nissan TIIDA (or similar) - Manual 1.6lt Z - Volvo S40 - Manual 2.4lt C - Nissan TIIDA (or Similar) - Automatic 1.6lt D - Honda Civic - Automatic 1.8 lt E - BMW 3.20i (or Similar) - Automatic 2.0lt F - Nissan X-Trail - Automatic 2.4lt K - Mercedes C Class - Automatic 1.8lt J - Nissan Double Cab 4X4 - Manual 3.0lt H - Nissan 2.7 Diesel LDW (or similar) - Manual 2.5lt I - Opel Zafira - Manual 1.8lt Y - Mercedes Vito - Manual 2.0lt Pickup Date: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2008 2009 2010 2011 2012 2013 2014 Total Rental Days: Total Days Allowed: Drop-off Date: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2008 2009 2010 2011 2012 2013 2014 Rental type: New Rental Extension Termination Other Name of Repairer: Telephone number: Registration Number: Make / Model: Colour: Remarks: Fill in E-mail Address for E-mail Carbon Copy of this Booking: Which Booking Assistant would you like to send your booking to: Maryke Amanda Francisca Esther Celeste
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