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Theft Claim Notification
1. Policy holder information
Policy holder name
What is your policy number?*
Are you a Business or an Individual?*
Business
Individual
Business Name (optional)
First name*
Surname*
Policy holder address
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
Your Contact Details
Are you the policy holder?*
Yes
No
First name*
Surname*
Mobile
Home Phone
Work Phone
Email*
Your preferred method of contact*
Mobile
Phone
Email
Best time of day to contact you
AM
PM
Nominate a representative to speak on your behalf
2. Claim Details
Incident Information
Has your car been recovered? *
Yes
No
Recovery Location *
Who informed you of the recovery? *
Where is the car now? *
Tell us in detail what happened *
Date and time your car was last seen *
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
Was your car locked?
Yes
No
How many sets of key are there?
- Select -
1
2
3+
Where were the keys located when the theft occurred?
Where are the keys now?
Who was the last person in charge of your car?
Did this person have permission to use your car?
Yes
No
First name of the last known person driving your car *
Surname of the last known 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 the theft occurred (or discovered) *
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?
Yes
No
Click on the box that describes where the damage is on your car
If your car has not been recovered please ignore this question.
Unsure
No panels damaged
All panels damaged
Passenger side
Passenger rear
Passenger front
Rear end
Driver rear
Driver side
Driver front
Front end
Bonnet
Roof
Windscreen
Window glass
Interior
Undercarriage
Engine
Burnt
Stripped
Reported to Police
Was the incident reported to the Police? *
Yes
No
Name of Officer
Police station the officer was from
Event/Report number if provided