Motor Insurance Claim Form

Commercial Motor Insurance Claim Form

Submit your motor claim. Please complete all relevant sections to ensure prompt assessment.
Important notice

You must answer all questions honestly and fully.

To help us process your claim quickly, please answer all questions as completely as possible.If a question is not relevant to your situation, please write "N/A".
Section 1: Insured / Business Details
Business Name
Insured Person Name

First NameLast Name
Phone Number
Format: 04 00000000.
Email Address
GST Registered? *
ABN
Input Tax Credit (ITC) Percentage
Insurer
Policy Number
Is the insured the preferred contact person?
Contact Details
Preferred contact person if not the insured details provided above.
Contact's First and Last Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: 04 00000000.
Email Address
Relationship to the insured

Section 2: Claims Details
Date of incident

DayMonthYear

MinutesAM/PM Option
Location of the incident

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
State
Driver Name
Driver Date of Birth

DayMonthYear
Vehicle Registration Number *
Drivers Licence Number *
Driver's Licence Expiry *

DayMonthYear
How long have you held your driver’s licence (for the class of vehicle involved in this claim)?
Vehicle Type
Licence Class

Section 3: Incident Details
Was there a third party involved?
Third Party Name
Third Party Vehicle Registration
Third Party Address
Third Party Phone
Format: 04 00000000.
Third Party Insurer Name
Third Party Claim Number
Description of claim
Is there damage to the insured vehicle? *
If your policy allows, would you like to nominate an insurer's repairer or use the insurer's nominated repairer?
Nominated Repairer Business Name
Nominated Repairer Suburb
Upload supporting documents or files to substantiate your claim eg. police report, images, quotes, invoices, photos etc.

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Were there any witnesses?
Witness Details

Commercial Motor Insurance Claim Form