Incident Claim Notification

Duty

When answering any questions or completing your claims details you need to be honest, accurate and truthful in your answer. We may reduce or refuse to pay your claim or cancel the policy if you have failed in this duty.

You confirm that you understand your Duties. Additionally, you confirm that you have read our Privacy Policy. You further understand that any advice provided to you on this website is general only and does not take into account your individual circumstances.

2. Claims details

Incident Information

Select the incident that best describes what has happened

- Select - Single car accident Multi car accident Storm damage Car damage whilst parked Malicious damage Fire damage

Tell us in detail what happened*

What was the weather condition? - Select - Dry Wet

What was the road condition? - Select - Unsealed Off-road Sealed

Is it alleged that anyone involved in the accident consumed alcohol or took any drugs within 12 hours prior to the incident? - Select - Yes No

Driver Details

First name of the person driving your car

Surname of the person driving your car

Driver licence number

Is the driver's licence valid?

Yes No

How long has the driver held a drivers licence? - Select - 1 Year 2 Years 3 Years 4 Years 5 Years 5-10 Years 10-15 Years 15+ Years

Driver licence expiry date

Date of birth

Is the driver nominated on the insurance policy?

Yes No

Incident Location

Street Number

Street Name

Street Type - Select - Avenue Boulevard Circuit Close Corner Court Crescent Drive Gardens Heights Highway Parade Parkway Road Street Way ---------- Alley Approach Arcade Brow Bypass Causeway Circus Copse Cove End Esplanade Flat Freeway Frontage Glade Glen Green Grove Lane Link Loop Mall Mews Packet Park Place Promenade Reserve Ridge Rise Row Square Strip Tarn Terrace Thoroughfare Track Trunkway View Vista Walk Walkway Yard

Suburb*

Postcode*

Location (if address unknown)

State / Territory - Select - NSW ACT VIC QLD NT SA WA TAS

Date and time of the incident*

HH 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23

MM 0 05 10 15 20 25 30 35 40 45 50 55

Your Car

Car Registration Number *

Make

Model

Year

Odometer Reading

Is there any finance on your car?

YesNo

Click on the box that describes where the damage is on your car

UnsureNo panels damagedAll panels damagedPassenger sidePassenger rearPassenger frontRear endDriver rearDriver sideDriver frontFront endBonnetRoofWindscreenWindow glassInteriorUndercarriageEngineBurntStripped

Was your car towed?*

YesNo

Where is your car now?

UnknownAt towing companyAt repairersAt residential addressWith the policeOther

Other car and driver

Did you obtain information about the other driver/s?*

YesNo

Third Parties

Third Party 1

First name

Surname

Street Number

Street Name

Street Type - Select - Avenue Boulevard Circuit Close Corner Court Crescent Drive Gardens Heights Highway Parade Parkway Road Street Way ---------- Alley Approach Arcade Brow Bypass Causeway Circus Copse Cove End Esplanade Flat Freeway Frontage Glade Glen Green Grove Lane Link Loop Mall Mews Packet Park Place Promenade Reserve Ridge Rise Row Square Strip Tarn Terrace Thoroughfare Track Trunkway View Vista Walk Walkway Yard

Suburb

Postcode

State / Territory - Select - NSW ACT VIC QLD NT SA WA TAS

Phone

Licence Number

Car registration number

Other driver's insurance company

Other driver's policy or claim number

Third Party 2

First name

Surname

Street Number

Street Name

Street Type - Select - Avenue Boulevard Circuit Close Corner Court Crescent Drive Gardens Heights Highway Parade Parkway Road Street Way ---------- Alley Approach Arcade Brow Bypass Causeway Circus Copse Cove End Esplanade Flat Freeway Frontage Glade Glen Green Grove Lane Link Loop Mall Mews Packet Park Place Promenade Reserve Ridge Rise Row Square Strip Tarn Terrace Thoroughfare Track Trunkway View Vista Walk Walkway Yard

Suburb

Postcode

State / Territory - Select - NSW ACT VIC QLD NT SA WA TAS

Phone

Licence Number

Car registration number

Other driver's insurance company

Other driver's policy or claim number

Third Party 3

First name

Surname

Street Number

Street Name

Street Type - Select - Avenue Boulevard Circuit Close Corner Court Crescent Drive Gardens Heights Highway Parade Parkway Road Street Way ---------- Alley Approach Arcade Brow Bypass Causeway Circus Copse Cove End Esplanade Flat Freeway Frontage Glade Glen Green Grove Lane Link Loop Mall Mews Packet Park Place Promenade Reserve Ridge Rise Row Square Strip Tarn Terrace Thoroughfare Track Trunkway View Vista Walk Walkway Yard

Suburb

Postcode

State / Territory - Select - NSW ACT VIC QLD NT SA WA TAS

Phone

Licence Number

Car registration number

Other driver's insurance company

Other driver's policy or claim number

Reported to Police

Was the incident reported to the Police?

YesNo

Did the Police attend?

YesNo

Did the Police indicate the responsible party?

YesNo

Responsible Party

Driver of my vehicleOther party

Name of Officer

Police station the officer was from

Event/Report number if provided

Injury

Was there anybody injured?

YesNo