Theft 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. 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?

YesNo

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?

YesNo

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?

YesNo

Click on the box that describes where the damage is on your car If your car has not been recovered please ignore this question.

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

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