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MAKE A CAR INSURANCE CLAIM.

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Claim in NetBank

We just need some more information...

Please provide the following

After your claim is submitted…

Please allow 24 hours for your claim number to be generated.

Once generated, you will receive an email advising you of your claim number and the next steps relating to your claim.

Any information received to support your claim will be reviewed within 10 business days and you will be kept updated with the progress of your claim every 20 business days.

Alternatively, if you require immediate assistance call 13 2423.

Required fields

Personal details

Your policy number

First name

Last name

Best contact number

Address

Suburb

Postcode

Is your vehicle registered for GST? Yes No

Vehicle details

Make and model

Year

Body colour

Registration number

Registration expiry

Is your vehicle financed? Yes No

Does your vehicle have any modifications or accessories? Yes No

Tell us about any modifications or accessories

Incident details

Tell us the date of the incident

Tell us the time of the incident

Was your vehicle being driven at the time of the incident? Yes No

Where did the incident happen? Tell us the street name or nearest intersection

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Suburb

Tell us how the incident happened in as much detail as possible

characters remaining.

Tell us about any damage to the vehicle in as much detail as possible

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Are you able to drive your vehicle? Yes No

Where's the vehicle now?

Was it towed? Yes No

Does it need to be towed? Yes No

Driver details

If the car was being driven at the time of the incident, who was driving? A listed driver on the policy Someone else

If the driver is not listed on the policy, add their details below.

Full name

Phone number

Did the driver consume any drugs or alcohol prior to the incident? Yes No

Where a third party was involved, please add their details below, if known.

A third party is an individual or entity that is involved in an event, but not one of the insured policyholders

Full name

Phone number

Registration number

Residential address

Criminal, claim and incident history

You will be asked some criminal, claim and incident history questions now.

In respect to this or any other type of insurance held by any of the Insureds or drivers, has any insurer in the last five years refused to pay or denied a claim? Yes No

Refused to offer cover or invite renewal
Cancelled or avoided cover
Imposed special conditions on a policy

Please provide your response below Yes No

If yes, provide details below

Fraud or dishonesty
Theft or robbery
Arson
Damage or threatened damage to property
Injury or threatened injury to another person
Drugs
Stolen goods

Please provide your response below Yes No

If yes, provide details below

Lost their licence or had restrictions applied, other than for a fine default
Had any accident or incidents involving loss or damage to a motor vehicle

Please provide your response below Yes No

If yes, provide details below

Is there anything else you'd like to add that could help assess and manage your claim?

characters remaining.

Before you submit your claim, can you confirm that the information you've provided is honest and accurate? Yes No

the information you have provided is accurate, complete and not misleading
you have read and understood Hollard's and CBA's Privacy Notices¹
if you are providing sensitive personal information (e.g. criminal history or health information) in this form, you consent to the collection, use and disclosure of that information for the purpose of administering your claim
if you are providing the personal information of others in this form, you confirm that you are authorised to do so on their behalf

Important information

¹Privacy Notice

Hollard's Privacy Notice

Hollard Insurance Partners Limited ABN 96 067 524 216 AFSL 235030 (‘Hollard’, ‘we’, ‘us’, ‘our’) is collecting the personal information on this form to verify your identity, assess and administer your claim, and to meet its obligations under the General Insurance Code of Practice. This information may include sensitive personal information, such as your criminal history or health information. For information as to how Hollard use and disclose personal information, please see the Privacy Notice in the Product Disclosure Statement (PDS). You must provide Hollard with accurate and complete information. If you do not, Hollard may not be able to assess your claim. Where you provide Hollard with the personal information of others, you must let them know before doing so and direct them to the Privacy Notice in the PDS. For further information, please see Hollard's Privacy Policy.

CBA's Privacy Notice

CBA collects your personal information that you submit on this form to Hollard for them to use as set out in their privacy notice above. CBA may collect some information from Hollard about your claim, such as its status and progress. We do this to manage our relationship with you and provide you with information through the services CBA provides. You can read more about the way CBA collects, uses and discloses information in CBA's Privacy Policy.

Car Insurance is provided and issued by Hollard Insurance Partners Limited ABN 96 067 524 216, AFSL 235030 (Hollard) and distributed by the Commonwealth Bank of Dubai ABN 48 123 123 124, AFSL 234945 (CBA). Hollard is not part of the CBA Group. CBA and its related entities do not sell, issue or guarantee the obligations or performance of Hollard or the products Hollard offers.

Click here should you need to refer to the Product Disclosure Statement (PDS) or any Supplementary PDS.

MAKE A CAR INSURANCE CLAIM.

We just need some more information...

Please provide the following

Personal details

Vehicle details

Incident details

Driver details

Criminal, claim and incident history

In respect to this or any other type of insurance held by any of the Insureds or drivers, has any insurer in the last five years:

In the last 10 years has any policyholder, driver or anyone else covered by this policy been charged with or found guilty of a criminal offence relating to:

In the last five years, has any policyholders or driver?

Before you submit your claim, please confirm the following: