Car Insurance claim form

When completing this claim form you need to be honest, accurate and truthful in your answers. We may reduce or refuse to pay a claim if you have not answered our questions in this way. By completing this form you are confirming that you have read our Privacy Policy.

Once your claim form has been received, a member of our Claims Team will call you within 3 business days to discuss your claim.

 

Your details

* Indicates mandatory fields

Please check your details are correct and try again.

Enter first name *
Enter last name *
Enter phone number *
Enter email address *


The rest of this form is optional - but will help in processing your claim

Address
Policy number

Driver details

Name of person driving your car
Driver date of birth
Please enter a date of birth that is 18 years or over.
Driver license number
Driver license expiry
Licence expiry date can not be a past date

Your car details

Car registration number

Was your car towed?

Company name
Address
Phone number

Incident details

Date of incident Date of incident
Time of incident Time of incident

{{500 - claimsData.incidentDescription.length}}

{{500 - claimsData.incidentDescription.length}}

Where did the incident occur

Did the incident involve another vehicle?

You have selected yes, please provide details of the other drivers

Driver name
Driver license number
Driver licence expiry
Licence expiry date can not be a past date.
Driver address
Driver's contact number
Car registration number

12 hours prior to the incident had you consumed any alcohol, drugs or prescription medication?

{{100 - claimsData.consumedDescription.length}}

{{100 - claimsData.consumedDescription.length}}

Was the incident reported to the police?

Police event number (if available)

We will ask for these details over the phone

Do you have any witness details? These details are optional but will help us to process your claim

Your driving history

In the last 3 years, has your licence had any cancellations or suspensions?

In the last five years, have you had any drink driving or drug related charges?

Do you have any restrictions or limitations on your licence?

Need help?

You can access your Car and Home Insurance 24 hours emergency claims line on

Customer Care

If you need more information or have any questions please contact us between 8am-8pm (AEST) Monday to Friday and 9am-5pm (AEST) Saturday and Sunday (except public holidays).

What are you covered for?