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Motor Insurance Claim Form (Ghana)

Motor Insurance Claim Form (Ghana)

Motor Insurance Claim Form

MOTOR INSURANCE CLAIM FORM submitted pursuant to Section 40 of the Insurance Act, 2006 (Act 724) and the Motor Vehicles (Third Party Insurance) Act, 1958 (Act 42).

Date of Claim Form: [Claim Date]

1. Policy and Policyholder Details

1.1

Policyholder Name: [Policyholder Name]

1.2

Address: [Policyholder Address]

1.3

Contact Number: [Policyholder Phone]

1.4

Insurance Company: [Insurer Name] (NIC-licensed insurer)

1.5

Policy Number: [Policy Number] | Class of Cover: [Policy Class] | Policy Period: [Policy Period]

2. Vehicle Details

2.1

Vehicle Make and Model: [Vehicle Make Model] | Year: [Vehicle Year]

2.2

DVLA Registration Number: [Registration Number]

2.3

Chassis / VIN Number: [Chassis Number] | Engine Number: [Engine Number]

3. Incident Details

3.1

Date of Incident: [Incident Date] | Time: [Incident Time]

3.2

Location: [Incident Location]

3.3

Type of Incident: [Incident Type]

3.4

Description of Incident: [Incident Description]

3.5

Ghana Police MTTD Report Number: [Police Report Number]

4. Third Party Details

4.1

Third Party Name: [Third Party Name]

4.2

Third Party Vehicle Registration: [Third Party Vehicle Reg] | Third Party Insurer: [Third Party Insurer]

5. Claim Details

5.1

Nature of Claim: [Claim Type]

5.2

Estimated Total Loss / Repair Cost: GHS [Estimated Loss]

6. Declaration

I, [Policyholder Name], declare that the information provided in this Motor Insurance Claim Form is true, complete, and accurate to the best of my knowledge. I authorise [Insurer Name] to obtain information from the Ghana Police Service, the Driver and Vehicle Licensing Authority (DVLA), and any medical practitioner in connection with this claim. I acknowledge that making a false or fraudulent claim is an offence under the Criminal Offences Act, 1960 (Act 29) and constitutes grounds for cancellation of my insurance policy under the Insurance Act, 2006 (Act 724).

Policyholder

________________

Signature

Maintained by Vladislav Sergienko, Founder·Template last modified: ·Report an error

What Is a Motor Insurance Claim Form (Ghana)?

A Motor Insurance Claim Form in Ghana records the particulars required for the matter it documents.

Section 40 of the Insurance Act, 2006 (Act 724) requires insurers licensed by the National Insurance Commission (NIC) to settle valid claims within 90 days of receipt of all required documentation. The NIC, established under Part I of Act 724, supervises all insurance companies in Ghana, sets minimum capital requirements, and handles complaints from policyholders against insurers. All motor insurers operating in Ghana must be registered with the NIC and must be members of the Ghana Insurers Association (GIA).

The Motor Vehicles (Third Party Insurance) Act, 1958 (Act 42) makes it a criminal offence under Section 1 to use or permit the use of a motor vehicle on a road in Ghana without a valid third-party insurance policy. The DVLA (Driver and Vehicle Licensing Authority), established under the Road Traffic Act, 2004 (Act 683), requires proof of a valid NIC-registered insurance certificate before issuing a road worthiness certificate or renewing a vehicle licence. The Ghana Police Service Motor Traffic and Transport Department (MTTD) enforces the compulsory insurance requirement at checkpoints throughout Ghana's 16 administrative regions.

A Motor Insurance Claim Form in Ghana must be distinguished from a Police Accident Report (Form 11), which is the official police record of a road traffic accident prepared by the MTTD, and from a Motor Vehicle Inspection Report, which is a technical assessment of vehicle damage prepared by an approved assessor. The claim form initiates the insurer's internal claims process, whereas the police report and inspection report are evidence submitted in support of the claim. Under Act 724, insurers may not unreasonably withhold settlement once valid documentation is submitted.

The legal framework governing the Motor Insurance Claim Form (Ghana) includes the Insurance Act 2006 (Act 724), the Motor Vehicles (Third Party Insurance) Act 1958 (Act 42), the Road Traffic Act 2004 (Act 683), the National Insurance Commission (NIC) Guidelines on Claims Settlement, and the Motor Insurance Bureau of Ghana (MIB) rules applicable to claims against uninsured drivers. Disputes between policyholders and insurers in Ghana are referred to the NIC Insurance Complaints Bureau or, for amounts exceeding its jurisdiction, to the High Court (Commercial Division) in Accra.

The legal framework governing the Motor Insurance Claim Form (Ghana) in Ghana draws on several key statutes and regulatory bodies. Under Ghanaian law, the Data Protection Act 2012 (Act 843) and the Data Protection Commission govern personal data processing. The Marriages Act 1884-1985 (Cap. 127) and Marriages Ordinance (Cap. 127) govern civil marriages. The Intestate Succession Law 1985 (PNDC Law 111) overrides customary succession for specified relatives. The Courts Act 1993 (Act 459) governs court procedures. The Children's Act 1998 (Act 560) governs child welfare. Parties executing a Motor Insurance Claim Form (Ghana) in Ghana should confirm the document reflects current law, including any amendments enacted since the original drafting date. The Insurance Act 2006 (Act 724) sets the foundational requirements.

When Do You Need a Motor Insurance Claim Form (Ghana)?

A Motor Insurance Claim Form in Ghana is required whenever a policyholder wishes to formally notify an NIC-licensed insurer of an event covered under their motor insurance policy and seek indemnification.

A Motor Insurance Claim Form is required immediately after a road traffic accident in Ghana involving damage to the insured vehicle, personal injury, or damage to third-party property. Under Section 40 of the Insurance Act, 2006 (Act 724), most motor insurance policies require notification within 24 to 48 hours of the accident. Late notification can prejudice the claim, and insurers licensed by the NIC may rely on a late-notification condition to reduce or refuse indemnity.

A Motor Insurance Claim Form is needed when a vehicle insured under a thorough motor policy has been stolen in Ghana. The policyholder must notify the Ghana Police Service Motor Traffic and Transport Department (MTTD) immediately, obtain a police extract (Police Form 11), and submit the claim form to the insurer within the period specified in the policy schedule.

A Motor Insurance Claim Form is required after a fire, flood, or other peril covered under a thorough policy causes damage to the insured vehicle. The insurer will appoint an approved motor assessor registered with the Ghana Insurers Association (GIA) to inspect and value the damage before authorising repairs at a panel-beating workshop.

A Motor Insurance Claim Form is needed when a third party (another road user, pedestrian, or property owner) makes a demand against the policyholder for compensation arising from a road traffic accident in Ghana. The policyholder must notify the insurer promptly and forward all third-party correspondence to enable the insurer to conduct the defence or negotiate settlement under the Motor Vehicles (Third Party Insurance) Act, 1958 (Act 42).

A Motor Insurance Claim Form is required by fleet operators — companies operating multiple commercial vehicles on Ghanaian roads — when any vehicle in the fleet is involved in an incident. Fleet policies issued by NIC-licensed insurers typically require the fleet manager to complete a standardised claim notification form within 48 hours of any incident.

Parties in Ghana should prepare a Motor Insurance Claim Form (Ghana) proactively rather than waiting for a dispute to arise. Courts interpret agreements based on the written terms rather than oral representations. Under Ghanaian law, the Data Protection Act 2012 (Act 843) and the Data Protection Commission govern personal data processing. The Marriages Act 1884-1985 (Cap. 127) and Marriages Ordinance (Cap. 127) govern civil marriages. The Intestate Succession Law 1985 (PNDC Law 111) overrides customary succession for specified relatives. The Courts Act 1993 (Act 459) governs court procedures. The Children's Act 1998 (Act 560) governs child welfare. Where the transaction involves regulated activities, prior approval from the relevant authority may be required before execution.

What to Include in Your Motor Insurance Claim Form (Ghana)

A valid Motor Insurance Claim Form in Ghana under the Insurance Act, 2006 (Act 724) and NIC claims-settlement guidelines must contain the following essential elements.

Policyholder and Policy Details: Full legal name of the policyholder, National Identification Authority (NIA) Ghana Card number or passport number, contact address and telephone number, the insurance policy number, the name of the NIC-licensed insurer, the policy period, and the class of cover (third-party only, third-party fire and theft, or thorough) under the policy schedule issued pursuant to Act 724.

Vehicle Details: Make, model, year of manufacture, colour, engine number, chassis number, and the vehicle registration number assigned by the Driver and Vehicle Licensing Authority (DVLA) under the Road Traffic Act, 2004 (Act 683). The roadworthiness certificate number and expiry date must also be provided.

Description of the Incident: Date, time, and exact location of the accident or loss event (identified by road name, town, and region in Ghana), direction of travel, weather and road conditions at the time of the incident, and a narrative description of how the accident occurred. The description must align with the statement given to the Ghana Police Service Motor Traffic and Transport Department (MTTD) on Police Form 11.

Third-Party Details: Where applicable, the name, address, vehicle registration number, and insurer of any third party involved in the accident, together with the names and contact details of independent witnesses. This information is required for the insurer to exercise subrogation rights against the third party's insurer under Act 724.

Police Report Reference: The MTTD police report number and the name of the police station that attended the scene or accepted the report, as required by most NIC-licensed insurers before processing a claim under thorough or third-party policies.

Nature of Claim and Estimated Loss: A statement of the type of claim (repair costs, total loss, theft, personal injury, third-party property damage), supported by a preliminary estimate of the loss value in Ghana Cedis (GHS).

Declaration and Signature: A signed declaration by the policyholder confirming that the information is true and complete, authorising the insurer to obtain information from the Ghana Police Service, DVLA, and any medical practitioner, and acknowledging that making a fraudulent claim is an offence under the Criminal Offences Act, 1960 (Act 29) and grounds for policy cancellation under Act 724.

The forms-legal.com Motor Insurance Claim Form (Ghana) template covers all mandatory elements under Act 724 and NIC guidelines and includes a checklist of supporting documents: police extract, DVLA registration certificate, roadworthiness certificate, driver's licence, repair estimate, and photographs of the damaged vehicle. Policyholders should also refer to a Motor Vehicle Bill of Sale (Ghana) when the vehicle has recently changed ownership to confirm insurable interest.

Additional compliance elements for a Motor Insurance Claim Form (Ghana) used in Ghana include: Under Ghanaian law, the Data Protection Act 2012 (Act 843) and the Data Protection Commission govern personal data processing. The Marriages Act 1884-1985 (Cap. 127) and Marriages Ordinance (Cap. 127) govern civil marriages. The Intestate Succession Law 1985 (PNDC Law 111) overrides customary succession for specified relatives. The Courts Act 1993 (Act 459) governs court procedures. The Children's Act 1998 (Act 560) governs child welfare. Forms-legal.com provides this template as a starting point for Ghana-compliant documentation.

Sources & Citations

Statutory citations link to official government sources.

  1. Marriages Ordinance (Cap. 127)HK official

Cite this page

Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Motor Insurance Claim Form (Ghana) (Ghana) [Legal document template]. Forms Legal. https://forms-legal.com/ghana/personal/insurance/motor-insurance-claim-form-ghana

MLA

"Motor Insurance Claim Form (Ghana) (Ghana)." Forms Legal, 2026, https://forms-legal.com/ghana/personal/insurance/motor-insurance-claim-form-ghana.

BibTeX
@misc{formslegal-motor-insurance-claim-form-ghana,
  author       = {{Forms Legal}},
  title        = {Motor Insurance Claim Form (Ghana) (Ghana)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/ghana/personal/insurance/motor-insurance-claim-form-ghana}},
  note         = {Free legal document template}
}

Frequently Asked Questions

Statute-referenced template — Template last modified June 2026

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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