Apply for Claim

Making a Claim

Did you come across an emergency with your vehicle? Reach out to us within 48 hours and provide the details of the incident. You can start filling up the forms here for initiating the claim process, and we will start with report making procedure. We suggest you inform us of all incidents, irrespective of whether you wish to claim assurance benefits or not.

As you report your claim, we will contact you in 24 hours and assign you a Claim Service Specialist. The person will be your dedicated representative and, as a dedicated, knowledgeable, and committed professional, will lead you through the entire claim process.

For queries or concerns, please call us on 03 904 24 777

or scan the following QR Code to download our claim form
Please use Computer/Laptop to fill up the form with better interface.

    Who are you? MemberDriver

    Member Details

    Membership Number:

    Fleet Registration Kilometer
    Make Model Month/Year
    Registered Owner Name Mobile Number
    Address: Suburb

    Email Address:

    Taxi Driver Details

    First Name Surname
    Address: Suburb
    State Postcode Date Of Birth 
    Mobile Home/Work

    Driver Email

    Licence Number Expiry Date  Years Held

    Did the driver consumed any alcohol or taken any drugs in the 24 hours prior to the accident? YesNo

    Did the driver undergo a breath test, breath analysis or blood test? YesNo 

    What was the reading?  


    Incident Details

    Date  Day Time 
    Street Name Suburb

    Nearest Crossroad 

    Road Surface  Number of Vehicle(s)
    At the time of incident, the covered vehicle was  Traffic Controls  Your Direction of Travel 


    1. Google Map

    2. Accident Images

    3. Our Vehicle

    4. Other Vehicle

    Accident drawing

    please complete a diagram of the accident. Please include all street names, road markings, street signs, control signs and the direction each vehicle was travelling at the time of impact. If you need more room, please attached a separate sheet of paper.


    Accident Description

    - Describe how the accident happened

    Estimate the speed of your vehicle Estimate the speed of other vehicle 

    Was your vehicle towed? YesNo

    Towed by

    Towed To

    Where is vehicle now?


    Mark the damage to Vehicle & third-party Vehicle

    [Download Now]


    Other Vehicle Description

    RegistrationNumber Make/Model/Colour
    Driver First Name Driver Last Name

    Owner details

    Address Suburb
    State Postcode Date Of Birth 
    Mobile Home/Work


    Insurance Company Detail Claim Number

    Is there any Passenger in Vehicle? YesNo

    Passenger Name Passenger Email
    Passenger Mobile Number Passenger Home/Work Number

    Was anyone injured? YesNo



    Police Information

    Did the Police attend the accident YesNo Was the accident reported to Police YesNo

    Officer Name

    Station QP Number


    Witness Details



    Mobile number Home/Work Number


      TRC P/L Staff Driver of Taxi
    Print Name