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Motor Insurance Claim

You can lodge an online claim anytime – 24 hours, 7 days a week.

1. Insured Details

Policy Number

Client Reference Number

Insured Name(Required)

Insured's Address(Required)

Insured's Email(Required)

Insured's Phone Number(Required)

Are you registered for GST?(Required)

Yes

No

What is your Australian Business Number (ABN)?(Required)

Are you entitled to claim on input tax credit on this policy?(Required)

Yes

No

Input Tax Credit %(Required)

2. Driver Details

For parked or unattended vehicles, Driver = Vehicle custodian at time of loss

Drivers Name(Required)

Are drivers contact details same as Insured Details above?(Required)

Yes

No

Driver Address(Required)

Driver Email(Required)

Driver Phone Number(Required)

Driver Date of Birth(Required)

MM slash DD slash YYYY

Drivers Licence Number(Required)

Drivers Licence Expiry Date(Required)

MM slash DD slash YYYY

Drivers Licence Years Held(Required)

Are you an employee of the Insured?(Required)

Yes

No

Any traffic convictions or been involved in any motor vehicle accidents in the past 5 years?(Required)

Yes

No

State relationship to Owner of Vehicle(Required)

Please give details of conviction or involvement.

Had any alcohol or drugs been consumed in previous 12 hours by the driver?(Required)

Yes

No

Please give details of type and amount of alcohol or drugs consumed.(Required)

3. Insured Vehicle Details

Vehicle Make(Required)

Other Vehicle Make(Required)

Year(Required)

Insured's Vehicle Rego Number(Required)

Registered owner of Vehicle(Required)

Vehicle Use(Required)

Private

Business

Is there finance on the insured vehicle?(Required)

Yes

No

Name of Finance Company(Required)

4. Loss Details

Date of Accident(Required)

MM slash DD slash YYYY

Time of Accident(Required)

Hours

:

Minutes

AM/PM

Address where the accident occured(Required)

How did the accident happen?(Required)

Who do you consider to be at fault?(Required)

Myself/Driver

Other

Unknown

5. Damage to Insured Vehicle

Was your vehicle damaged?(Required)

Yes

No

Would you like us to assist with organising a Motor Repairer?(Required)

Yes

No

Have you obtained a repair quote?(Required)

Yes

No

Name of your preferred repairer(Required)

Where is your vehicle now?(Required)

Which panels were damaged?(Required)

No Panels Damaged

All Panels Damaged

Passenger Side

Passenger Rear

Passenger Front

Rear End

Driver Rear

Driver Side

Driver Front

Front End

Bonnet

Roof

Windscreen-Window

Interior

Undercarriage

Engine

Burnt

Stripped

6. Damage to Other Vehicle(s)

Was another vehicle involved in the accident?(Required)

Yes

No

Other Driver’s Name

Address of Other Driver(Required)

Other Drivers Phone Number(Required)

Other Drivers Licence Number(Required)

Other Vehicle Make / Model(Required)

Other Vehicle Reg No:(Required)

The other Insurance Company(Required)

Policy Number/Claim No

Damage to other vehicle(Required)

Please attach photos if possible

Was a third vehicle involved in the accident.(Required)

Yes

No

Please give details of other vehicle(s)(Required)

7. Damage to Property

Did the accident cause any property damage?(Required)

Yes

No

Please describe property damage(Required)

8. Witness/Police Details

Was there a witness to the accident?(Required)

Yes

No

Witness Name(Required)

Independent witness or passenger?(Required)

Independent

Passenger

Contact details for witness(Required)

Was there a second witness to accident?(Required)

Yes

No

Witness Name(Required)

Was second witness independent or passenger?(Required)

Independent

Passenger

Contact details for second witness(Required)

Did a Police Officer take particulars?(Required)

Yes

No

Name/Station/Incident No.(Required)

9. Payment Details

If your claim is accepted, would you like the funds deposited into your bank account to ensure a prompt settlement?(Required)

Yes

No

Bank Name

Account Name

BSB

Account Number

ATTACH RELATED DOCUMENTS/PHOTOS

Please include all photos and/or documents related to this claim

Attach Files (8 Files allowed. Max size per file is 4MB).

Drop files here or

Max. file size: 512 MB.

Why not give us a call?

Phone: 0240 818 789

0240 818 789

RENSURE-web

If you want to find out more about our services, visit our contact page and tell us about your business.

Renovatio Insurance Pty Ltd ABN 62625941773 Authorised Representative No: 1265593 of McLardy McShane Partners Pty Ltd AFSL No: 232987 ABN: 14 064 465 309

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