Motor Vehicle Accident Report Form

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

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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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Text is kept only in this browser tab so a refresh does not erase your progress. Photos, video and signatures are never stored in the browser.

Tell us when you are submitting this report and whether your car was at fault.

Date of Submission *

YOUR CAR *

At FaultNot At Fault

Registration Number *

Make *

Model *

Year *

Full Name *

Date of Birth *

Contact Number *

Email Address *

Street Address *

Suburb *

State *

Licence Number *

Licence Expiry Date

Use of Vehicle at time of accident *

WorkPrivate

Same as driver

Insurance Company

Policy Number

Claim Number

Type of Cover