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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 we receive to support your claim will be reviewed within 10 business days and we will keep you updated with the progress of your claim every 20 business days.

Alternatively, if you require immediate assistance call us on 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

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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

We need to ask 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 us 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 our Privacy Notice*
if you are providing sensitive personal information (e.g. criminal history or health information) in this form, you consent to CommInsure’s collection, use and disclosure of that information for the purpose of administering your claim
if you are providing the personal information (including sensitive personal information) of others in this form, you confirm that you are authorised to do so on their behalf.

Important information

*Privacy Notice

Commonwealth Insurance Limited ABN 96 067 524 216 AFSL 235030 (‘CommInsure’, ‘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 we use and disclose personal information, please see the Privacy Notice in our Product Disclosure Statement (PDS). You must provide us with accurate and complete information. If you do not, we may not be able to assess your claim. Where you provide us 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 our Privacy Policy.

Car Insurance is provided by CommInsure, a registered business name of Commonwealth Insurance Limited ABN 96 067 524 216 AFSL 235030 (CIL). CIL is a wholly owned non-guaranteed subsidiary of Commonwealth Bank of Australia ABN 48 123 123 124 (The Bank). The Bank does not guarantee the obligations or performance of CIL or the products it offers. This information is provided by CIL and where we refer to 'we' 'us' and 'our', we mean CIL. Download a Car Insurance Product Disclosure Statement (PDS) and Financial Services Guide (FSG) or call 13 2423 for a paper copy.

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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: