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

AutoGuard Maintenance Plan Details

Enter Plan Type(Required)

Enter Plan Number(Required)

Service Request Type(Required)

Preferred Service Provider (for Tyre Related Services)(Required)

If Other (Specify)

Preferred Service Provider (for Rim Related Services)(Required)

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)

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.