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info@gkelawyers.com.au
(02) 9958 2407
info@gkelawyers.com.au
(02) 9958 2407
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Home
Practice Areas
Property
Conveyancing
Buying a Property
Selling a Property
Family Law
Divorce Lawyers
Litigation
Civil Litigation
Commercial Litigation
Business Litigation
Debt Recovery
Document Witnessing & Certifying
Motor Vehicle Accident Claims
Notarial Services
Personal Injury
Wills & Estates
Wills
Will Disputes
Estate Planning
Probate
Our Team
George Elmassian
Support Team
Contact Us
Blog
Online Accident Details Form
IMPORTANT
To process your recovery we require the following:
Registration papers
Driver Drivers Licence
Signed Authority to Act signed by Owner
TEL: 02 9958 2407
EMAIL: claims@elmassianlawyers.com.au
Repairer Details
Repairer Name
*
Repairer Phone
*
Not At Fault Party Details (Your Car)
Driver
Driver's Title
*
Mr
Ms
Mrs
Driver's Name
*
Driver's Email
*
Driver's Phone
*
Driver's Address
*
Driver's Suburb
*
Driver's Postcode
*
Registered Car Owner
Car Owner's Title
*
Mr
Ms
Mrs
Car Owner's Name
*
Car Owner's Email
*
Car Owner's Phone
*
Car Owner's Address
*
Car Owner's Suburb
*
Car Owner's Postcode
*
Vehicle Details
Your Vehicle Make
*
Your Vehicle Model
*
Your Vehicle Year
*
Your Vehicle Reg No.
*
Insurance Details
Insurance Company Name
*
Insurance Cover
*
Your Vehicle Year
Third Party
None
Hire Car Required?
*
Yes
No
Replacement Car Company Used
At Fault Party Details (Other Car)
Driver
Other Driver's Title
*
Mr
Mrs
Ms
Other Driver's Name
*
Other Driver's Email
Other Driver's Phone
*
Other Driver's Address
*
Other Driver's Suburb
*
Other Driver's Postcode
*
Other Driver's Licence Number
*
Registered Car Owner (Other Car)
Other Car Owner's Title
*
Mr
Mrs
Ms
Other Car Owner's Name
*
Other Car Owner's Email
Other Car Owner's Phone
*
Other Car Owner's Address
*
Other Car Owner's Suburb
*
Other Car Owner's Postcode
*
Other Car Details
Other Car's Make
*
Other Car's Model
*
Other Car's Year
*
Other Car's Reg No
*
Other Driver's Insurance Details
Other Driver's Insurance Company
*
Other Driver's Insurance Cover
*
Comprehensive
Third Party
None
Insurance Company Phone
*
Claim Number
*
Witnesses
Witness Name
Witness Email
Witness Address
Witness Phone
Accident Details
Weather Condtions
Dry
Wet
Raining
Date of Accident
*
Traffic Conditions
Light
Moderate
Heavy
Time of Accident
*
No. of Vehicles Involved
*
Place of Accident - Street
*
Place of Accident - Suburb
*
Accident Description
Please give a full details description of what happened including cross streets, number of lanes each way, vehicle lane you were in, traffic signals, speed you were doing, moving or stationary):
Draw diagram of accident using:
A = Not at fault car (your car)
B = At fault car
C = Any other car’s involved
Then upload the file here:
File Upload
Drop your file here or click here to upload
You can upload up to 1 files.
Injuries
Has the driver or passenger(s) been injured?
*
Yes
No
Police Report
Did Police Attend?
*
Yes
No
Was the matter reported to the police?
*
Yes
No
Police Report/Event Number
Date Incident Reported
Police Officer's Name
Station
Was Anybody Booked?
*
Yes
No
If yes, charged with:
Submit
