Breakdown Taxi Fare Claims Form


As part of your Annual Bicycle Insurance from Yellow Jersey, you are covered for the cost of a taxi should you suffer a mechanical breakdown or be involved in an incident which damages your bike and prevents you from completing your journey. It is intended to cover the costs of getting you back to a safe place if an incident has left you stranded without a working bicycle.

The policy allows you to take a taxi to: The nearest suitable cycle repair shop, the nearest appropriate railway station, the nearest car rental agency, the nearest overnight accommodation or the insured location noted on your policy, whichever is closest. You can claim up to £150 per event, and make up to three breakdown claims per period of insurance. As part of your claim, we will require a receipt for the taxi fare as well as evidence that you could not complete your journey by bicycle.

We cannot commence dealing with a claim until we are in receipt of ALL the necessary documentation.
If you need help with any part of the form, you can call Direct Group on 0333 003 0600, 9am to 5:00pm, Monday to Friday

ABOUT YOU

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INCIDENT DETAILS

WITNESSES

CIRCUMSTANCES

Have you ever had cycle insurance with another insurer?

YesNo

Do you have any criminal convictions which you are required to disclose under the rehabilitation of offenders act at the date of your original insurance application?

YesNo

Have you ever had a policy cancelled or void by an insurer?

YesNo

Have you ever been refused renewal or had special terms imposed?

YesNo

DECLARATION

I declare that the information contained in this form is true to the best of my knowledge and I have not withheld any information connected with this claim. I accept that if I exaggerate any part of this claim, or make any false declaration or statement, I shall not be entitled to receive any benefit under this policy in respect of this claim. Furthermore, I accept that any such action on my part may render me liable to prosecution. I further agree to provide any further information or documentation as may be reasonably required. I understand that you may seek information from other insurers to check answers that I have provided. By returning this form electrically via the Yellow Jersey website in the absence of a signature constitutes acceptance of the declaration.

IMPORTANT NOTICE: Insurers and their agents share information with each other to prevent fraudulent claims and for underwriting purposes via the Claims Underwriting Exchange register operated by Insurance Datatype Services Ltd. A list of participants is available upon request. The information you supply on this form, together with the information you have supplied on your insurance and any other information related to the claim, will be supplied to participants.


Please tick the box to show you have read and agreed to the above declaration

YES