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Our Team
The Bruce Experience
Insurance Products
Business Insurance
Business Insurance
Professional Indemnity Insurance
Cyber Protection Insurance
Management Liability Insurance
Workers Compensation Insurance
Public Liability Insurance
Strata Insurance
Trades Insurance
Trades Package Insurance
Public Liability Insurance
Personal Accident Insurance
Tools of Trade Insurance
Machinery and Equipment Insurance
Motor Insurance
Electrician’s Insurance
Carpenters Insurance
Painters Insurance
Dental Essentials
Dental Practice Insurance
Management Protection Insurance
Workers Compensation Insurance
Practice Indemnity Insurance
Public Liability Insurance
Cyber Protection Insurance
Medical & Health Professionals
Medical Practice Insurance
Management Protection Insurance
Medical Indemnity Insurance
Practice Indemnity Insurance
Workers Compensation Insurance
Public Liability Insurance
Personal Insurance
Income Protection Insurance
Trauma Insurance
Life and Total & Permanent Disability Insurance
Home and Motor Insurance
Investment Property Insurance
Key Person & Business Expenses Insurance
Make a Claim
Business Insurance Claim
Dental Essentials Claims
Personal Insurance Claim
Professional Essentials Claim
Trades Insurance Claim
Contact Us
GET A QUOTE
Motor Accident Insurance
Claim Form
Submit your claim
Page: Claims - Motor Accident
"
*
" indicates required fields
Personal information of insured
Insured Name
*
Email
*
Phone
*
Policy number
*
Insurance Product
*
Business Insurance
Trades Insurance
Medical & Health Professionals
Dental Insurance
Personal Insurance
Vehicle year, make and model
*
Vehicle registration number
*
Driver's details
Driver's name
*
Date of birth
*
DD slash MM slash YYYY
Licence number
*
Licence class
*
Licence expiry date
*
DD slash MM slash YYYY
Years licence held
*
Have you had any traffic convictions or been involved in any motor vehicle accidents in the past five (5) years? (if YES, please provide details)
*
Have you been convicted of or had any fines or penalties imposed for any criminal offences in the last 10 years? (if YES, please provide details)
*
Did you consume alcohol or take drugs during the 12 hours prior to the accident? (if YES, state how much and when)
*
Did you undergo a breath test or blood test for alcohol or drugs? (if YES, what was the result)
*
Did you refuse to undergo any of the above tests?
*
Yes
No
Accident details
Vehicle use
*
Business
Private
Date of accident
*
DD slash MM slash YYYY
Time of accident
*
Location of accident: street, suburb, post code
*
How did the accident happen?
*
Who do you consider was at fault?
*
Myself
Other driver
Were there any witnesses to the accident?
*
Did the police attend the accident? (if YES, please provide the police report number)
*
Was your vehicle damaged?
*
Yes
No
Was your vehicle towed away? (YES/NO). If YES, where is your vehicle now? Please provide Full address and Phone No
*
Damage to other vehicle or property
Name of the other driver
*
Residential address
*
Phone number
*
Licence number
*
Vehicle year, make and model
*
Registration number
*
Other driver's insurance company/claim number
*
Additional Information (optional)
Do you have a supporting quote, invoices or photo’s that will assist us to lodge your claim with your insurer? (If yes – please email these to
claims@bruce.com.au
).
Name
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