Lodge A Claim

Vehicle Details


Owners Details


Driver's Details


Accident Details


Police Details

Did the police attend the scene YesNo
Has the accident been reported to police? YesNo

Details of Third Party:


Details of Any Wittnesess:


Things To Remember:

1. The driver and the owner must remain in Australia for the duration of the recovery which includes all court proceedings.

2. The driver and the owner must attend court to provide evidence where liability in regards to the accident is an issue.

3. The owner of the vehicle must ensure that the driver is available for all the court proceeding, where liability for the accident case is an issue. Failure to do so will result in the owner being responsible for all the costs payable to the third party.

4. You must provide accurate information as to the circumstances of the collision. Providing inaccurate and /or misleading information will result in Rideshare Cover Inc not indemnifying the driver and /or the owner. The driver and/or owner will be responsible for all court orders and the costs made against the plaintiff.


Declaration:

To be completed by the driver

Date
Driver's Signature

To be completed by the Owner

Date
Owner's Signature

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03 9769 0088