Glove Box Guide

Glove Box Guide - Complete and Submit this form

It is an offence not to stop and render assistance in the event of an accident. You are required to provide your name and address and Licence details. If you feel threatened or a 3rd party will not provide contact details you should immediately contact the police.

Take all reasonable measures to protect people and property and prevent further loss
Identify all third parties and potential witnesses (record their details)
If possible digital images of damage to your vehicle, other vehicles and property may be useful later
Record details of Tow Truck operator and Repairer where your vehicle is being taken if it is towed
Do not drive your vehicle unless you are absolutely sure it is safe and no further damage will be caused
Do not leave your vehicle unsecured at the scene unless injury or safety prevent removal

Your Details

* Indicates required field

Your Drivers Name *

First

Last

Name of our Insured (if different) *

Date of Accident *

Your Vehicle Rego No. *

Your Vehicle Description *

Are you still driving Vehicle *

Where is your Vehicle now / Where is it being taken *

Your Drivers Licence No. *

Your Phone Number *

Your Email *

Place/location of Accident *

Description of Accident *

3rd Party Details (Driver)

3rd Party Driver Name *

First

Last

3rd Party Driver Phone No. *

3rd Party Driver Email *

Other Vehicle Rego. No. *

Other Vehicle Description *

3rd Party Driver Licence details *

3rd Party Driver Address *

Suburb and Postcode *

3rd Party Owners details (if not driver)

3rd Party Owners Name *

First

Last

3rd Party Owners Email *

3rd Party Owners Phone No. *

3rd Party Owners License No. *

3rd Party Owners address *

3rd Party Owners Suburb and Postcode *

Additional 3rd Party or Witnesses

Select One *

Name *

First

Last

Phone Number *

Their Email *

Address *

Their Suburb and Postcode *

Licence Details *

Their Vehicle Rego No. *

Description of their Vehicle or Property *

If more 3rd parties or witnesses are involved please submit this form and then complete additional forms

Submit

Glove Box Guide - Complete and Submit this form

Your Details

3rd Party Details (Driver)

3rd Party Owners details (if not driver)

Additional 3rd Party or Witnesses

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