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REQUEST MAINTENANCE
Request maintenance
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Request maintenance
AUTOGUARD MAINTENANCE REQUEST
Name
(Required)
First
Last
ID No:
(Required)
Contact Number
(Required)
Email Address
(Required)
Title
Mr.
Mrs.
Ms.
Dr.
Vehicle Information
Make
(Required)
Model
(Required)
Vehicle Registration Number
(Required)
VIN Number
(Required)
Tyre Brand
(Required)
Tyre Size
(Required)
Alloy Rim
(Required)
Stock
Aftermarket
Diamond Cut
(Required)
Yes
No
AutoGuard Maintenance Plan Details
Enter Plan Type
(Required)
Enter Plan Number
(Required)
Service Request Type
(Required)
Wheel Alignment
Puncture Repair
Tyre Replacement
Alloy Rim Repair
Alloy Rim Replacement
Preferred Service Provider (for Tyre Related Services)
(Required)
Trentyre Namibia
Tiger Wheel & Tyre Namibia
Other
If Other (Specify)
Preferred Service Provider (for Rim Related Services)
(Required)
Mag Rim Repairs Namibia
Other
If Other (Specify)
Location for Service Request
(Required)
Town
Suburb
Note:
• This is not an insurance product but a redeemable plan on presentation of a valid plan number.
• You will be responsible for the payment of repairs or restoration work completed by the repairer that falls outside the scope of this agreement. Refer to your Maintenance Schedule for Payout % amounts based on remaining tread depth.
Damage Report:
Wheel Component
(Required)
Left Front Tyre
Left Front Alloy
Right Front Tyre
Right Front Alloy
Left Rear Tyre
Left Rear Alloy
Right Rear Tyre
Right Rear Alloy
Spare Tyre
Spare Alloy
Remaining Tread Depth (mm)
Damage Description
(Required)
Vehicle Front
(Required)
Max. file size: 20 MB.
Vehicle Back
(Required)
Max. file size: 20 MB.
Vehicle Side
(Required)
Max. file size: 20 MB.
Damaged Panel/Rim/Tyre
(Required)
Max. file size: 20 MB.
*Disclosure: Please submit a seperate benefit redemption request for each wheel component.
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