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CUSTOMER INFORMATION/DETAILS
Name *
Gender *
Male
Female
Male
Contact No. *
Highway *
Lebuhraya Damansara-Puchong (LDP)
Lebuhraya Damansara-Puchong (LDP)
Lebuhraya SPRINT
Lebuhraya Kesas
Lebuhraya Smart
Email *
FEEDBACK
Subject *
Location *
Incident Date *
Details *
ATTACHMENT
File Description
Uploaded File
ATTACHMENTS
Certified True Copy of Police Report *
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Identification Card (Owner and Driver) *
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Driving Licence of the Driver *
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Toll transaction statement *
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Repair Bill or Quotation *
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Photos of Damage *
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After Repair Photos *
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Vehicle Insurance Policy/Cover Note *
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Vehicle Registration Card *
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Discharge Voucher from claimant’s Motor Insurance Provider (if the claimant had submitted a claim against their own motor insurance policy) *
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Medical Report and Medical Bill (for physical injuries, if any) *
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