Motor Vehicle Accident Report Form

Required fields are marked *. Dates use DD/MM/YYYY.

01About five minutesYour text is protected if the page refreshes

02No customer accountOne secure submission, then a reference

03English or 中文Switch language without losing your answers

Step 1 of 5

About you & your vehicle

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Claim basics

Tell us your understanding of responsibility. This is not a final decision about liability. The submission date is recorded automatically.

Date of Submission *

In your view, who was responsible for the accident? *

I was at faultThe other party was at faultShared responsibilityUnsure

Vehicle Details

Registration Number *

Make *

Model *

Year *

Driver Details — name & contact

Full Name *

Date of Birth *

Contact Number *

Email Address *

Driver Details — address & licence

Street Address *

Suburb *

State *

Postcode *

Licence Number *

Licence Expiry Date

Use of Vehicle at time of accident *

WorkPrivate

Registered Owner

Same as driver

Insurance Details

Insurance Company

Policy Number

Claim Number

Type of Cover