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Vehicle details
Registration number
*
Registration state
*
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ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Is this a company car?
Yes
No
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Contact details
First name
*
Last name
*
Address
Contact number
*
Email address
*
Were you driving the vehicle at the time of the incident?
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:
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:
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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
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Claim Notification