Online Claim Form
Contact Information
Customer Number
Company Name
Contact Name and Surname
Email:
Phone:
Vehicle Information
Plate Number
Brand/Model
Delivery Date of the Vehicle
Detailed Description of your Claim
What do you expect from BCA? (please mention the amount of your claim)
Add Photos and/or Documents
(File formats accepted: pdf, jpg, tiff, png, gif.
Individual files must not exceed 5MB in size. The combined total size of all uploaded files must not exceed 20MB.
)
The asterisk "
*
" denotes a required field
Contact Information