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Accident Details Form

If you’ve recently been in an accident and you would like RecoverCorp to assist you with your claims, please fill in the form below.

Or

Your Vehicle

This section corresponds to the details for the vehicle we are claiming for.
If you chose to let RecoverSmart handle your claims, we will require sufficient information. Please fill out all the fields in detail.

Vehicle Details

Make

Model

Year

Registration Number

Owner Details

First Name

Last Name

Contact Number

Contact Email

Address

Suburb

State

Driver Of Vehicle

First Name

Last Name

Contact Number

Contact Email

Address

Suburb

State

Claim Information

Do you have insurance on your vehicle?

Repairer

Who is your repairer?

Other Party's Vehicle

This section covers the details for the vehicle we are claiming against.
If you choose to let RecoverSmart handle your claims, we will need sufficient information.

Vehicle Details

Make

Model

Year

Registration Number

Driver of Vehicle

First Name

Last Name

Contact Number

Contact Email

Address

Suburb

State

Claim Information

Did they have insurance on their vehicle?

Insurance Company

Claim Number

Accident Details

To assist in swift and decisive action, we require a detailed recount of the events that occured.
Please give us as much information as possible

Date of accident

Time of accident

Location

Describe the accident

 

We understand sometimes it's easier to picture what happened during the accident when you put it to paper.

Please draw up a diagram to help us understand the scene of the accident. Use symbols from the legend below to show certain elements from the scene.

Required Information

Other required information for your claim

Do you required a hired car?

In your vehicle driveable?

Were there any witnesses?

If yes, please provide any of their details

Name of witness

Contact Number

Name of witness

Contact Number

Was anybody injured?

Was the accident reported to the police?

If yes, please provide any of the following details.

Report / Event Number

Date reported

Station

Officer's Name

Authorisation

I give authority to RecoverSmart Pty Ltd to:

  • Act on my behalf as an agent and represent myself.
  • Send and receive documents related to my claim.
  • Arrange a quote and assessment for my claim.
  • Receive and pay anybody owed money related to this claim.

Name

Date

 I hereby declare that all the information provided is true and correct to the best of my acknowledgement. I accept all responsibility if the above information has been falsified or if relevant information has been withheld.