SATISFACTION NOTE SURVEY – HGI

SATISFACTION NOTE

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CLAIMS DETAILS:

NAME OF THE ASSURED:

Title (*)

Surname (*)

First Name (*)

Middle Name

Policy Number (*)

Claims Number (*)

Date of Car Delivery (*)

VEHICLE DETAILS:

Make: (*)

Model: (*)

Registration Number: (*)

WORKSHOP DETAILS:

Select Garage (*)

SURVEY:

On a scale of 1 to 7. Please rate your satisfaction with the claims process: (*)

Please give reasons behind your score: (*)

DECLARATION:

I/We declare that the repair/damage to my/our vehicle with details above upon reporting the accident which occurred on or about the above date of loss and which was the subject of the above claim number has been carried out satisfactorily by the Workshop stated above and that I/We do not have any further claims against the company in respect of the said accident and that the payment of the repairer's bill shall constitute a full discharge of my/own claim for such a damage.

Write Signature: (*)

Signed Date: (*)