Motor Vehicle Claim

Important Information

You're about to begin a Motor or Fleet claim.

Make sure you have the following details available before you start:

Your policy information
Any information about the accident including; the date, where the damage occurred, and details of any other people, vehicles or property involved.
Be sure to include any attachments such as repair quotations, photos of the accident damage or any other third party correspondence

Please complete all the mandatory (*) areas of the form

CCI handles your personal information with care and in accordance with the Privacy Act 1988 and the Australian Privacy Principles. For information about how to access and or correct the personal information we hold about you read our Privacy Policy or Complaints Policy.

General Insurance Code of Practice

The General Insurance Industry has developed the General Insurance Code of Practice (the Code) for use by insurers.

CCI has adopted and enthusiastically supports the Code because it:

requires the provision of high standards of good practice and service
requires the provision of more relevant and useful information to consumers
promotes understanding of your rights and obligations under our insurance contracts
promotes informed and effective relationships between consumers, insurers and agents
provides a process for the resolution of disputes.

The Code sets out what we must do when dealing with you through all stages of our relationship with you - whether you're taking out insurance, making a claim (including setting out timeframes for making a decision on your claim), require financial hardship assistance or have a complaint. The Code also contains special provisions setting out how we must deal with claims resulting from catastrophes and disasters.

If you want more information about the Code, or to obtain a copy of the Code please contact us or visit the Insurance Council of Australia website at here.

If we are unable to provide you with insurance cover, CCI will:

give you reasons for our decision;
refer you to another insurer, Insurance Council of Australia or NIBA for information about alternative insurance options (unless you already have someone acting on your behalf); and
if you are unhappy with our decision, make available information about our complaints handling procedures.

To use this service, you have to agree to our terms service and privacy policy, to agree please check the box.

I have read and understood CCI's Privacy Policy and procedures in handling and disclosing my personal information.

I have read and understand the Code of Practice procedures and will provide CCI with all information.

Client Details

Please complete your details below

Please provide the Client Name

Client Name (Policyholder) *

Please provide the Client Address

Please provide the Client Suburb

Address *

Suburb *

Please select the Client State

Please provide a valid Client Post Code

State *

Post Code *

Please provide a valid Policy Number or Client Number

Policy Number

Please provide a valid Policy Number

Client Number

Please provide a valid Client Number

Contact Details

Please provide details of your key contact for any follow up relating to this claim

Please provide the Contact Surname

Please provide the Contact First Name

Surname *

First Name *

Please provide the Contact Address

Please select the Contact State

Address *

State *

Please provide the Contact Suburb

Please provide a valid Contact Post Code

Suburb *

Post Code *

Please provide a valid ITC between 1-100%

Please provide a valid Contact Email

If you are a registered business, to what extent are you entitled to claim an Input Tax Credit (ITC) on the GST for this policy? (%)

Email *

Please enter a Landline or Mobile Number

Please enter a valid Mobile Number

Please enter a valid Phone Number

Phone

Mobile

Vehicle Details

Please enter a valid Year of Manufacture

Please select the vehicle Make

Year of Manufacture *

Make *

Please enter the vehicle Model

Model *

Please enter a valid vehicle Registration Number

Please provide a valid number of seats

Registration No *

Number of seats? *

Please select if the Vehicle is subject to finance

Vehicle is subject to finance? *

Driver Details

Please select if you are the driver

Are you the driver? *

Please provide the Driver First Name

Please provide the Driver Surname

Title

First Name *

Surname *

Please provide a valid Driver Date of Birth in DD/MM/YYYY format

Date of Birth *

Please enter a Landline Number or Mobile Number

Please enter a valid Driver Phone Number

Phone

Please enter a valid Driver Mobile Number

Mobile

Please indicate if the driver holds a valid licence

Does the driver hold a valid driver's licence? *

Please enter a valid Drivers Licence Number

Drivers Licence Number *

Accident Details

Please provide details of the accident below

Please select a valid Accident Date in DD\MM\YYYY format

Accident Date

Accident Location

Please provide the Street

Street/Road *

Please provide the Suburb

Suburb/Town *

Accident Description

Please provide a short description of the accident

Description *

Please indicate if the insured vehicle was damaged

Was the insured vehicle damaged? *

Please indicate if the police were involved

Were the police involved? *

Officer Name

Police Station

Please indicate if the vehicle was towed

Was your vehicle towed? *

Company Name

Location vehicle towed to?

Accident Information

Please attach any relevant documents, photos or quotes related to this claim.

Add Attachment

Vehicle Damage

Please indicate all damage to your vehicle below

Damage Location

Damage Type

Damage Location

Damage Type

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Were any other vehicles or property involved

Third Party Details

Please provide any details of the third party or parties involved in the accident.

Name

Address

Please enter a valid Post Code

Town/Suburb

Post Code

State

Vehicle Registration number

Make

Model

Insurer

Claim number

Policy Number

Summary

Please provide your Full Name

I declare that all the information contained in this claim is correct.

You are about to submit your claim. Please make sure you check all information carefully.

Once you submit your claim, you will receive an email with a PDF copy of your claim details.

A member of our claims team will then contact you within 1 business day to discuss your claim.

If you have any questions about the progress of your claim, please contact 1800 011 028.

Completed at 20/01/2020 8:25 AM

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