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Motor Vehicle Claim Form

Non theft motor vehicle claim form.

Step 1 of 14

7%
  • Motor Vehicle Claim Form (Non theft)

    The issue of this form does not constitute an admission of liability on the part of the insurer.

    Save and Continue: If you need to, you may save and continue completing this form at a later time. Click the 'save and continue later' link at the bottom of any page to do so.
    NOTE: Do NOT use the back button in your browser, use the PREVIOUS/NEXT buttons at the bottom of each page to go back and forward.

    Important: Please complete all sections.

    AND Attach one quotation from repairer
    (at the end before submitting).
  • The Insured

  • Vehicle Details

  • Driver Details

  • Max. file size: 64 MB.
  • Incident Details

  • MM slash DD slash YYYY
  • :
  • Include:
    1. Name streets.
    2. Indicate direction of travel.
    3. Your Vehicle.
    4. Other vehicle.
    Accepted file types: pdf, jpg, png, Max. file size: 5 MB.
  • Damage To Your Vehicle

  • For example. Front bumper dented, right side passenger door dented and scratched, front right headlight broken etc.
  • Owner of Other Vehicle

  • Driver of Other Vehicle

  • Other Vehicle

  • For example. Front bumper dented, right side passenger door dented and scratched, front right headlight broken etc.
  • Other Parties

    Give details of pedestrians, owners of property of owners of animals involved.
  • Police

  • MM slash DD slash YYYY
  • Accepted file types: pdf, jpg, png, Max. file size: 4 MB.
  • Witness(es) Details

  • Witness 1


  • Witness 2

  • Owner(s) and Driver History

    In the last 5 years have you as owner or the driver of this vehicle:
  • 2. Been convicted or charged with:
  • (include any not reported or not claimed from an insurer)
  • Name of DriverDate of IncidentDetails of IncidentInsurerPerson at Fault 
  • Quotation

  • Accepted file types: pdf, jpg, png, Max. file size: 4 MB.
  • Declaration and Authorisation

    The information and answers given above are true and complete in every detail.
    I understand the claim may be refused or reduced if information if withheld.
  • The Insured

  • MM slash DD slash YYYY

  • The Driver

  • MM slash DD slash YYYY
  • Click below to enable your claim to be submitted.
  • This field is for validation purposes and should be left unchanged.

Contact

Tel: (03) 9879 7699
Fax: (03) 9879 7155
Email: insurance@augib.com.au

Important Information

AFSL 227 200
ABN 90 007 367 535
Privacy Policy

Links

NIBA
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AIG Travel Insurance

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