Britax Crash Exchange Program Personal InformationFull name* Address* Address City State ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Mobile phone number*How many car seats were affected in the accident? 1 2 3 4 5 6 HiddenPosition of your child in the car? 1 2 3 4 5 0 Child InformationYour child’s age?Please enter a number from 0 to 10.Age in month or yearMonthYearChild's date of birth DD dash MM dash YYYY Your child's height (in cm)Please enter a number greater than or equal to 1.Your child's weight (in kg)Please enter a number greater than or equal to 1.Vehicle InformationVehicle yearVehicle make (brand) Vehicle model Vehicle series Vehicle body type Sedan Hatch Wagon SUV Coupe How was the car seat installed in the vehicle? Fitted professionally Not fitted professionally Fitted using ISOFIX Fitted using vehicle seat belt Child Car Seat Information (1)Car seat model name One4Life, Dualfix i-size, Grow-With-You, Advansafix i-size, KidFix i-size, Highpoint, etc.Car seat colour Date of Purchase DD dash MM dash YYYY Please attach a copy of your purchase receipt*Max. file size: 10 MB.Please attach a photo of the car seat labels and serial numbers*Max. file size: 10 MB.Child Car Seat Information (2)Car seat model name One4Life, Dualfix i-size, Grow-With-You, Advansafix i-size, KidFix i-size, Highpoint, etc.Car seat colour Date of Purchase DD dash MM dash YYYY Please attach a copy of your purchase receiptMax. file size: 10 MB.Please attach a photo of the car seat labels and serial numbersMax. file size: 10 MB.Crash DetailsHave you made a claim for your car seats with your insurance company?* Yes No Please attach police report and/or insurance claim form*Max. file size: 10 MB.Please attach photo(s) of the child restraint after the accident*Max. file size: 10 MB.Please attach visible damage photos of the vehicle after the accident*Max. file size: 10 MB.Date of the vehicle accident DD dash MM dash YYYY Please provide a detailed description of the accident*Crash Exchange Program – Terms and Conditions* I agree to the Crash Exchange Program's terms and conditionsTERMS AND CONDITIONS The Terms and Conditions listed below, apply when submitting an application under the Britax Crash Exchange Program. The Britax Crash Exchange Program is open to all Singapore and Malaysia residents who have purchased a Britax child restraint in Singapore or Malaysia within the last 10 years or less. - This voluntary exchange program is being conducted at the sole discretion of Britax. - Submitting an application to this program does not automatically result in an exchange. - Upon review of the crash circumstances in combination with all the requested supporting documentation, Britax will determine if an exchange is warranted based on the program criteria. - Restraints are eligible for exchange if they have been involved in a severe crash in Singapore and Malaysia, and meet all stated criteria. (A severe crash is considered as being one where the main body structure of the vehicle is distorted). - The Britax child safety restraints that are available for exchange under this program, include all Infant restraints, Convertible Restraints, Forward-Facing Restraints, Convertible Booster Seats, Booster Seats. *Booster Cushions and child harnesses are not eligible. Infant restraints used for commercial use or hire are not eligible. - Only restraints branded Britax are eligible for exchange. - The original purchase of restraint must be made within the last 10 years or less and an original proof of purchase must be submitted as evidence when applying for an exchange. - Restraints purchased second hand are not eligible for exchange. - All required documentation (including scanned originals of supporting documentation), must be submitted via email as part of the request for exchange validation purposes. - The mandatory support documentation to be included in the application is: * Name, address and contact details; * Original Receipt/Proof of Purchase * Clear photograph/s of vehicle after road crash; * Clear photograph/s of crashed child restraint; * Detailed description of crash; * Official Police Report; * Copy of vehicle repairers detailed assessment; * Restraint details (serial number and manufacturing date). Applications that include all of the above documentation must be submitted online. - Completed applications must be submitted to Britax within 28 days of the road crash in order to be eligible for the Crash Exchange Program. - The date of the crash will be deemed as the date stated on the Vehicle Repairers Assessment or the Police Report. - Applications received after this 28 day period are not eligible for the Crash Exchange program and will not be considered. - The affected seat (crashed restraint) will be required for testing and evaluation and must be available for return to Britax. The request to return the crashed restraint will be made by Britax after confirmed receipt of all of the above documentation. - Britax will arrange collection of the crashed restraint. - If an application meets all above criteria and is approved, a replacement child restraint will be issued within 28 days of receiving documentation and the crashed restraint. - A suitable replacement will consist of a restraint of similar value and features to the crashed restraint. The choice of the replacement will be determined by Britax and is not negotiable. Britax will arrange delivery of the replacement restraint (via post). - Britax is not responsible for any lost, misdirected or damaged goods. - The Britax Crash Exchange Program is not to be used in addition to an insurance claim. Some insurance companies may offer car insurance which covers or partially cover the replacement of a child restraint. Please contact your relevant insurance company for further details. The insurance company may require that a crashed restraint be retained for their assessment purposes, which must be considered if applying for the Britax Crash Exchange. If an insurance payout is sought and/or issued for a replacement child restraint, you will not be eligible to apply for an exchange under this program. - All applications and supporting documentation remain the property of Britax. - In the event an exchange occurs, the applicant automatically consents to allow Britax to use submitted photos and testimonials for marketing purposes. Disclaimer: This program for crashed child restraint exchange is voluntary. This Crash Exchange Program does not involve a financial reimbursement or any offer other than a replacement of an equivalent child restraint as determined by Britax. Britax reserves the right to change, alter, amend or cancel any terms & conditions or the entire program at any time for any reason at our sole discretion without prior notice or obligation.NameThis field is for validation purposes and should be left unchanged.