Suzuki Secure Advantage Roadside Assistance Customer Claim Form
Complete this form when claiming reimbursement for Roadside Assistance or
Emergency Travel Expense
Important:
Please refer to the Suzuki Secure Advantage booklet for coverage details.
Submit all claims, fully documented, within 20 days of disablement.
Please retain a copy of all receipts and send original documentation.
Please include original paid receipts, validated by the service establishment, which
clearly detail the nature of the service provided.
1. Your Suzuki Secure Membership Number is your
vehicle identification number
2. Owner Information
3. Roadside Assistance Claim
4. Emergency Travel Expense Claim (maximum $300)
Meals:
$
Accomodation:
$
Commercial Transportation:
$
Rental Vehicle:
$
Other: (Please Specify)
$
Detailed Description:
5. Details of Your Vehicle Disablement
6. Make Cheque Payable To (If Different From Owner):
(enter the 17 digit vehicle identification number - VIN)
You must include the following documents:
* Paid receipts for reasonable covered expenses
incurred within 3 days of disablement.
* For disablement due to collision, a copy of the
Accident Report which was filed with the appropriate
police authority.
Date:
Location:
Cause
Mechanical Breakdown (please specify):
Other (please specify):
7. "I have completed this form and certify that the information provided is complete and accurate."
Signature of owner
Date
8. Sign and mail this completed form with original receipts to:
Suzuki Secure Advantage Roadside Assistance
P.O. Box 190, 135 West Beaver Creek, Richmond Hill, ON L4B 4R5
Road Service: $
Towing: $
(maximum $100)
(maximum $75)
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Apt
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