CARAVAN CLAIM FORM
Caravan vehicle insurance
POLICY HOLDER INFORMATION
Name
*
First Name
Last Name
Address
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
I would you like to direct this request to a particular OVIB broker
Broker's name
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Next
CARAVAN & DRIVER INFORMATION
Caravan details
*
I.e.. Year, make & model
Vehicle registration
*
Is the driver the same as the policy holder listed above?
*
Yes
No
Driver name
*
First Name
Last Name
Driver contact details
*
If different to your contact details above
Driver date of birth
*
-
Day
-
Month
Year
Licence Number
*
Licence state of issue
*
Please Select
VIC
NSW
QLD
TAS
SA
WA
NT
ACT
Licence class
*
Please Select
Full driver licence
Heavy vehicle licence
Probationary licence
Learner permit
Licence expiry
*
-
Day
-
Month
Year
Had you consumed any drugs or alcohol 12 hours prior to the accident?
*
Yes
No
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INCIDENT DETAILS
Date of accident
*
-
Day
-
Month
Year
Approximate time of accident
*
Minutes
AM
PM
AM/PM Option
Address where damage occurred
*
E.g. Great Alpine Rd OVENS
What happened?
*
Was the vehicle parked at the time of damage?
*
Please Select
Yes
No
Is the vehicle towable?
*
Please Select
Yes
No
Was the caravan towed?
*
Yes
No
If yes, location of caravan now
Address
What damage has your vehicle sustained?
*
Have you obtained a quote for repairs?
*
Yes
No
If yes, name and address of repairer
Name & Address
Were any of your personal effects damaged?
*
Yes
No
If so, please list items below
Does your vehicle have any pre-existing damage?
*
Yes
No
Did the police attend the incident?
*
Yes
No
If yes, name and station of officer
Name & Address
Please include photos of damage
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Were there any third parties involved in the incident?
*
Yes
No
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THIRD PARTY DETAILS
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Address
Vehicle details
I.e.. Year, make & model
Vehicle registration
Insurer name
Policy number
Description of damage to third party's property
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Were there any witnesses to the incident?
*
Yes
No
Unknown
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WITNESS DETAILS
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Address
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SETTLEMENT DETAILS
Please provide your bank account details here to assist with potential claim payments
Account name
BSB
Account Number
Are you registered for GST?
Yes
No
ABN
DECLARATION AND AUTHORISATION
I confirm I have checked all the information contained in this document and hereby verify the truth and accuracy of the information contained in this document
*
Yes
No
Please verify that you are human
*
Submit
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