Make a Claim

It is our policy for all team members to welcome every comment and suggestion we receive as a welcomed opportunity to communicate with our community, partners, and consumers so we’ve made it easy to do so.

Claimant*

Registered owner of vehicle*

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Year, make & model of vehicle repossessed

Vehicle Identification Number*

Home address

City

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Best contact phone number

Date of Statement

Date of Repossession

Did you witness the repossession take place?

Yes

What time did it occur?

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Did you see the damage done? If yes, describe the circumstances related to the damage occurring

Did you speak to the repossessor?

Yes

Did you surrender the keys to the vehicle?

Yes

Can you describe the equipment used to repossess the vehicle?

Was the vehicle towed from the front or the rear?

Towed from Front

Towed from End

Was the vehicle parked rear end in or head in?

Rear end in

Head in

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Where was the vehicle parked at the time of repossession?

Has the vehicle been previously involved in any accident?

Yes

If yes, when?

Describe any previous damage

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Who was the last person to drive the vehicle?

Before discovering the damage, when was the last time you saw the car?

Was the car locked last time you saw it?

Yes

If yes, did you park the car where it was repossessed from?

Yes

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Where did you redeem your vehicle?

Date and time

Please describe the damage in detail

Was there any aftermarket equipment installed on the vehicle? If yes, please describe

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Was there a police report made?

Yes

If yes, provide information

Have you obtained an estimate for the alleged damages?

Yes

If yes, attach a copy

Upload - Max 25mb

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Are there any pictures available of the vehicle or the incident?

Yes

If yes, attach a copy

Upload - Max 25mb

Are you aware of any video of the incident?

Yes

If yes, attach a copy

Upload - Max 25mb

If too large please submit video clips to claims@alohaadjusters.com.com and put the date of the incident, Vin number if any in the subject line, reference your name in the email.

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Were there any witnesses to this claim?

Yes

If yes, provide information

What proof do you have to show that the damage wasn’t there before the vehicle was repossessed?

Attach supporting document

Upload - Max 25mb

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Do you have full coverage insurance on the vehicle?

Yes

If yes, provide information

Please list all items that you are claiming as damaged and their estimated value at the time of the loss (factor in estimated wear and tear).

If you are providing replacement costs, you must note: ITEM DESCRIPTION, ESTIMATED REPLACEMENT COST, DATE ORIGINALLY PURCHASED

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Please read*

I understand that my full name below certifies, under penalty of perjury, that the information submitted by me is true and correct.

I understand that any false or misleading information submitted by me will result in a denial of this claim and possible criminal prosecution, under state law for insurance fraud.

Attach a legible copy of your State issued identification or your claim will not be considered. Your failure to cooperate will result in a denial of your claim.

Your cooperation with the claims handler during our investigation is necessary to properly evaluate your claim. Your lack of cooperation may result in a denial of your claim.

Our investigation, which may consist of, but not limited to, interviewing witnesses and individuals who may have any knowledge of the issues described by you. This may include, but is not limited to, your neighbors, repair shops, your lender, the original selling dealer, and others we determine to be relevant t the claim submitted.

By electronically executing this claim form, I am declaring, under penalty of perjury, that the information contained herein is true and correct. I understand that the submission of false information is a crime and may result in the filing of a criminal complaint to the local law enforcement and a request for criminal prosecution and/or punishment.

I understand that my signature below certifies, under penalty of perjury, that the information submitted by me is true and correct.

Enter your full name to proceed*

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Any Question?

Company Info

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What To Do

Contact Us

Mailing Address