Complex Fraud Investigations Instruction Form - Cuvva Fraud Type (Please select) Pre-inception loss Staged/contrived Induced Theft Fire/flood Fraud ring Credit hire Exaggerated losses Policy - spoofing Policy - driver not insured Policy - drive not identified (MIB) Policy - ghost brokering/fronting Policy - motor trade Policy - misrepresentation Malicious damage/vandalism Other If you have no Fraud concerns and the instruction concerns Liability only, please complete the document version of the instruction form and send it to motor.admin@questgates.co.uk. If Other, please specify Client Name Cuvva Limited Underwriter Company Name Please enter one of the following options: IQUW Syndicate Management Limited / Wakam UK / Wakam File Handler First Name TPA file handler File Handler Last Name Your Reference Policy Reference Urgent? (Please select) Yes No If so, reason, litigated, credit hire, portal deadline, etc. Policyholder Title Mr. Mrs. Ms. Mx. Dr. Miss Hon. Rev. Rabbi Rep. Sen. Master Sir Lady Policyholder First Name Policyholder Last Name Policyholder Date of Birth Policyholder Email Address Policyholder Phone Number Policyholder Address Line 1 Policyholder Address Line 2 Policyholder City Policyholder Postcode Policyholder Occupation Policyholder Vehicle Registration Number Policyholder Vehicle Make and Model Reasonable Adjustments? Interpreter Required? (Please select) Yes No Spoken Language Third Party First Name Optional - If no third party details are available, please move on to the 'Date of incident' heading Third Party Last Name Third Party Address Line 1 Third Party Address Line 2 Third Party City Third Party Postcode Third Party Phone Number Third Party Vehicle Registration Third Party Vehicle Make and Model If multiple claimants, please provide details Please state Full Name, Address, Postcode and Phone Number Date of Incident Time of Incident Location of Incident Policyholder's version of events Reason for Referral Please include the details of any witnesses or companies of concerns etc. Policyholder Reserve Third Party Reserve Total Reserve if unsure please provide an estimate total reserve Notes about the Reserve Number of Keys Keys with Insured (Please select) Yes No Keys with Insurer (Please select) Yes No Current location of the vehicle Has the vehicle been deemed a total loss? (Please select) Yes No V5C supplied and attached via email? (Please select) Yes No Engineer's report supplied and attached via email? (Please select) Yes No Purchase receipt supplied and attached via email? (Please select) Yes No
