Motor Vehicle Claim Form

Ensure you have details of the other driver and their vehicle and any witness names and contact details.

To assist rapid processing of your claim :

• If stolen report the loss to the Police
• If damaged and if other vehicle involved report the accident to the police.
• Obtain a quotation for the repairs of the damage from a recommended repairer
• Download the claim form and complete it
• Fax all information to our office on (08) 9433 3411 or contact your insurer direct

*The claim form can be opened in Adobe Acrobat Reader (Click here to download and install this free program if it's not already on your system) You can complete the form in that application using the editable fields provided prior to printing it out if preferred. Type Xs into the check boxes as required. Only your signature and the date need to be completed in pen after printing out the form.

Motor Vehicle Claim Form (440 KB)