Not at Fault Car Accident Claim | Free Repairs Melbourne

Your Vehicle

Rego *

Make *

Model *

Year *

Is your vehicle insured? *

Yes No

Was someone else driving your vehicle at the time of the incident? *

Yes No

Is the vehicle registered under a business? *

Yes No

Owner Details

First Name *

Last Name *

Street Address *

Suburb *

Postcode *

State *

Contact Number *

Email *

Owner Licence

Licence Number *

Licence Expiry *

Date of Birth *

Upload Front of Licence *

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Upload Back of Licence *

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To process your Not At Fault Claim, we require the Offending Vehicle's Registration Number as a minimum. If you have any other information about the at-fault party, please provide it in the fields below to help support your claim.

Offending Vehicle Details

Rego *

Make

Model

Year

Do you know if their vehicle is insured? *

Yes No Not Sure

Do you have any of the offending vehicle owner's contact details? *

Yes No

Was someone else driving their vehicle at the time of the incident? *

Yes No Not Sure

Accident Details

Date of Accident *

Time of Accident *

Place/Location of Accident *

Description of Accident *

Was the incident reported to Police? *

Yes No

Do you have a witness? *

Yes No

Mark Damaged Areas of Your Vehicle *

Click on the areas of the car to mark where the damage occurred.

Upload Photo

Draw a Diagram of the Accident *

Use the tools below to draw a diagram of how the accident happened.

Shapes:

Upload Hand-Drawn Diagram

What You Should Do

Before you sign this form contact us if you have any questions.
Complete the details on this form fully and truthfully. Provide as much information as possible.
Sign and return the form to us. Our address is on the first page.
Be prepared to provide us with a copy of the vehicle registration certificate and any other information about the collision.
If you are comprehensively insured, lodge a claim form with your insurer marked "Report Only". This will protect your rights and will not affect your no claim bonus if a claim is not made.
Refer any communications from the offending party or their insurers to us. Do not communicate directly with these people.

What We Will Do

Ensure that your vehicle is assessed by qualified assessors. There is no need for you to obtain any further quotes.
Make a claim on the offending party or their insurers. Upon recovery of funds, we will pay the repairer directly for the repair cost.
All costs and charges will be paid by the offending party or their insurance company. The repairer will also contribute to these costs and charges.

Authority to Act

I / We instruct Auscarz Group to act on my / our behalf to recover the losses arising from the collision as set out on this form.

I / We authorise Auscarz Group to:

Do all things necessary for the conduct of the recovery action including settling the claim, provided that the settlement covers all the costs arising from the collision and I have no further liability to any person.
Negotiate an agreeable cost of repairs directly with the referring repairer to enable a settlement to occur.
Commence legal proceedings (following any necessary advice from Auscarz Group) provided that the referring repairer and Auscarz Group are responsible for all costs incurred.
Pay the referring repairer and any other service providers (e.g. assessor, rental vehicle provider) directly for any expenses properly incurred.

I / We have been made aware of section 60 of the GICOP.

Do you have a preference of repairer? *

Yes No

Signature of Owner *

Draw your signature below using your mouse or touchscreen.

Not-at-Fault Car Accident Claim Form — We Handle Everything For You

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Your Vehicle

Owner Details

Owner Licence

Offending Vehicle Details

Owner Details

Offending Owner Licence

Driver Details

Offending Driver Licence

Accident Details

Mark Damaged Areas of Your Vehicle *

Draw a Diagram of the Accident *

What You Should Do

What We Will Do

Authority to Act

Signature of Owner *

Thank You!

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