Elmassian

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

    Not At Fault Party Details (Your Car)

    Driver

    Registered Car Owner

    Vehicle Details

    Insurance Details

    At Fault Party Details (Other Car)

    Driver

    Registered Car Owner (Other Car)

    Other Car Details

    Other Driver's Insurance Details

    Witnesses

    Accident Details

    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:
    Drop your file here or click here to upload

    Injuries

    Police Report