Customer Incident Form

Please complete the following incident form so we can assist you.

IMPORTANT

This form is to be used to register an incident for Yakima/Prorack/Whispbar failures that have resulted in damages sustained to property.
Note if this is a warranty claim regarding missing or damaged items please contact your local retailer or place of purchase.
Please note that you are required to submit your proof of purchase as well as photos to assist us in resolving your claim.
If you require assistance with installing / using your product please refer to your fitting instructions or contact your dealer.

ALL ITEMS MARKED WITH * ARE MANDATORY

Claim Title

Please add your last name followed by today's date. e.g. Smith - 1 Jan 2019*

Your Details

First Name*		Last Name*
Address Line 1*		City*
Address Line 2		State*
Country*		Postcode*
Phone*		Email*

Purchase/Installation Details

Place of Purchase*	Date of Purchase*	Pick

Place of Installation	Date of Installation*	Pick
Were the item/s professionally installed?*
Please detail the products purchased involved in this incident. Please provide the product code/s and name of the product. If you are unsure please check on our website, proof of purchase or on the product. If you cannot locate these details please provide an explanation of the item. Please also provide the 4 digit batch number of the product. This is usually found on a black or white sticker. You can include images of the product in the "ATTACHMENTS" section below.*

Vehicle Details

Make*		Model*
Year*		Registration Number*
Body Type*		Roof Type

Incident Details

Weight of load being carried inc. bars and accessories (kg)*		Speed at time of Incident (km/h)*
Date of Incident*	Pick	Location of Incident*
Type of road*		Incident Weather Conditions*
Tie down method*		Have you lodged with your insurance provider?*

What was being carried: Please provide as much detail about the items you were carrying.*

Describe in detail what led to the incident and how it occured.*

Proposed Solution

Please outline your proposed solution below. NOTE: If you are claiming for damage to a vehicle or damaged items, we will require 2 quotes for repairs/replacement or proof of purchase for the damaged item/s.*

Attachments

Please attach any relevant documents, images and files that will help your claim. The below images are required in addition for all Roof Rack Claims*

Please note that only 1 (one) file can be uploaded. We recommend you compress ('zip') your files before sending them to us. Compression makes uploading faster, especially for large files, and allows you to send multiple files as a single compressed file. Our preferred compression tool is 7ZIp. For access please visit 7-ZIP Compression Software

If for any reason you can not use 7Zip please email your attachments to warranty@yakima.com.au with the Claim Title as your subject line.

Front, Angled	Side View	Leg (Cover Off)

Additional Notes

Please add any further details relevant to your claim for our warranty team to review. If you do not have any further notes please type N/A.*

Terms and Conditions

I confirm that I have read, understood and agree to the Warranty & Disclaimer statements via the links provided below by Yakima Australia Pty Ltd, Yakima Europe Coöperatief U.A. and/or Hubco Automotive Ltd.

I confirm that the information provided on this incident form is true and correct and I am aware that providing false or misleading information will null and void this claim. I confirm and understand that in some circumstances Yakima Australia Pty Ltd may require a Statutory Declaration be signed and witnessed by a Justice of the Peace prior to my claim being considered.

I agree*
Please type your name*
Today's Date