When Accidents Happen:
Fleet Services
Information Technology
Equipment & Services
Paint Refinishing
Detailing
SIDS High Quality Smash Repairs
- Sydney's PREMIER vehicle accident repairers
ONLINE CLAIM FORM
PART 1: Claimants Details
* indicates required field
Your Details
Your E-Mail
*
Owners Details
Name
*
Address
*
City
*
State
*
Postcode
*
Home Phone
*
Work Phone
*
Mobile Phone
*
Fax
*
Drivers Licence No
*
Expiry Date
*
(dd/mm/yyyy)
Driver Details
(if same as owner details put "as above")
Name
*
Address
*
City
*
State
*
Postcode
*
Contact Phone
*
Drivers Licence No
*
Expiry Date
*
(dd/mm/yyyy)
Date of Birth
*
(dd/mm/yyyy)
Owner Vehicle Details
Is Vehicle Drivable?
*
Yes
No
Insurance Company
*
Claim No
*
Make/Model
*
Registration No
*
Year
*
Type of Cover
*
-- Please Select Cover --
Greenslip
Third Party Property
Comprehensive
PART 2: At Fault Party Details
Owners Details
*
Name
*
Address
*
City
*
State
*
Postcode
*
Home Phone
*
Work Phone
*
Mobile Phone
*
Fax
*
Driver Details
Name
*
Address
*
City
*
State
*
Postcode
*
Contact Phone
*
At Fault's Vehicle Details
Insurance Company
*
Insurance Contact
*
Phone
*
Fax
*
Policy No
*
Claim No
*
Make/Model
*
Registration No
*
Year
*
Type of Cover
*
-- Please Select Cover --
Greenslip
Third Party Property
Comprehensive
PART 3: Accident Details
Accident Details
Date of Accident
*
Approx Time
*
Street
*
Suburb
*
If more than 2 vehicles involved, please provide details.
Name
Rego
Phone
Name
Rego
Phone
Witnesses if any.
Witness Name
Phone
Witness Name
Phone
Name of Charged
*
Police Station
*
Police Officers Name
*
Accident Description
*
PART 4: Smash Repairer Details
Smash Repairer
SR Name
*
Contact Name
*
Phone
*
Fax
*
Date of Quote
*
(dd/mm/yyyy)
Quote No
*
Date Assessed
*
(dd/mm/yyyy)
Authorised Hours
*
Date Vehicle Required
*
(dd/mm/yyyy)
PART 5: Replacement Vehicle
Why Replacement Vehicle is Required
Vehicle Registered
*
Business
Private
Occupation
*
Hours Worked
*
Approx KM's/ day
*
Reason for Vehicle
*
Public Transport Available
*
Drive Manual
*
Yes
No