When Accidents Happen:

Fleet Services

Information Technology

Equipment & Services

Paint Refinishing

Detailing

SIDS High Quality Smash Repairs - Sydney's PREMIER vehicle accident repairers

ONLINE CLAIM FORM

PART 1: Claimants Details
* indicates required field
Your Details
Your E-Mail *
Owners Details
Name*
Address*
City*
State*			Postcode*
Home Phone*			Work Phone*
Mobile Phone*			Fax*
Drivers Licence No*			Expiry Date*	(dd/mm/yyyy)
Driver Details (if same as owner details put "as above")
Name*
Address*
City*
State*			Postcode*
Contact Phone*
Drivers Licence No*			Expiry Date*	(dd/mm/yyyy)
Date of Birth*	(dd/mm/yyyy)
Owner Vehicle Details
Is Vehicle Drivable?*	Yes No
Insurance Company*
Claim No*
Make/Model*
Registration No*			Year*
Type of Cover*	-- Please Select Cover -- Greenslip Third Party Property Comprehensive
PART 2: At Fault Party Details
Owners Details*
Name*
Address*
City*
State*			Postcode*
Home Phone*			Work Phone*
Mobile Phone*			Fax*
Driver Details
Name*
Address*
City*
State*			Postcode*
Contact Phone*
At Fault's Vehicle Details
Insurance Company *
Insurance Contact *
Phone *			Fax *
Policy No *
Claim No *
Make/Model *
Registration No *			Year *
Type of Cover *	-- Please Select Cover -- Greenslip Third Party Property Comprehensive
PART 3: Accident Details
Accident Details
Date of Accident *			Approx Time *
Street *
Suburb *
If more than 2 vehicles involved, please provide details.
Name
Rego			Phone
Name
Rego			Phone
Witnesses if any.
Witness Name
Phone
Witness Name
Phone
Name of Charged*
Police Station *
Police Officers Name *
Accident Description *
PART 4: Smash Repairer Details
Smash Repairer
SR Name *
Contact Name *
Phone *			Fax *
Date of Quote *	(dd/mm/yyyy)		Quote No *
Date Assessed *	(dd/mm/yyyy)		Authorised Hours *
Date Vehicle Required *	(dd/mm/yyyy)
PART 5: Replacement Vehicle
Why Replacement Vehicle is Required
Vehicle Registered *	Business Private
Occupation *
Hours Worked *			Approx KM's/ day*
Reason for Vehicle *
Public Transport Available *
Drive Manual *	Yes No