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Vehicle details
Registration number
*
Registration state
*
...
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Is this a company car?
Yes
No
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Person reporting claim
First name
*
Last name
*
Address
Contact number
*
Email address
*
Were you driving the vehicle at the time of the incident?
Yes
No
Are you the point of contact for this vehicle?
Yes
No
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Driver history details
Date of birth (d/m/y)
*
Gender
Male
Female
Other
Not specified
Drivers licence number
Licence status
...
Full
Probationary
No Licence
Learner
Unknown
Licence class
...
Car
Motorcycle rider
Motorcycle rider restricted
Light rigid
Medium rigid
Heavy rigid
Heavy combination
Multi-combination
Expiry date
Age licence obtained in Australia
State licence is held
...
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
New Zealand
International
Has licence ever been suspended or cancelled?
Yes
No
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Incident details
Incident date
*
Incident time
*
What happened?
*
Damage description
*
Is the vehicle drivable?
Yes
No
N/A
Incident address
*
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Other parties
Were other vehicles involved?
Yes
No
Was any property damaged?
Yes
No
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Repairer details
Choose repairer closest to:
Reporter
Contact
Incident
Other address...
GPS
GPS Lat:
GPS Lng:
Max km:
1st Circle radius km:
2nd Circle radius km:
Max entries:
Zoom:
Temp Lat:
Temp Lng:
Selected repairer:
Search for Repairer
Refresh markers
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Photos
If you are able to provide photos of the damage to the vehicle this may speed up the damage estimate process. Images that are clear are best. Please provide at least two images.
Damage Close-ups
Damage from 5 paces
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Comments and Attachments
Comments/instructions
Attachments
Submit
Claim Notification