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OnePath Car Insurance - Online claim form

OnePath Car Insurance - Online claim form

Enter the details of your query ensuring all mandatory fields that are marked with an asterisk are completed. Press the 'submit' button to send your claim to a OnePath Customer Service Consultant.

* Required fields

Title: *

First name: *

Surname: *

Policy Number: * If unavailable type “not known”

Are you the
policy holder? *

Policy holder street name: *

Suburb: *

State: *

Postcode: *

Contact number: *

Email address: * If unavailable type “N/A”

Preferred method of contact? *

Claim Details

Has the incident been reported to the police?

Police report number:

Time & date of incident/event:

Location of event
street name: *

Suburb: *

State: *

Postcode: *

Registration number: *

Make: *

Model: *

Year of manufacture: *

Detailed description of event/loss: *

Is the car driveable?

Does the car require a tow? *

Where is the car now (address):

Have you obtained any quotes to repair the damage? *

Was there a 3rd party involved Yes No

Name of 3rd party driver:

Name of owner:

Address:

Contact details:

Registration number:

Licence number:

Make:

Model:

Year of manufacture:

Were there any witnesses? Yes No

Witness Details 1: name

Address:

Contact details:

Witness Details 2: name

Address:

Contact details:

Further Driver Information

In the last 5 years have you or any of the drivers of your vehicle had:

A claim, an accident, car stolen or burnt (even if not reported or not claimed for from an insurer)? * Yes No

Insurance refused, declined or cancelled by an insurer or special conditions imposed? * Yes No

Driver or motorcycle licence cancelled, suspended or endorsed? * Yes No

In the last 5 years have you or any of the drivers of your vehicle been convicted or charged with:

Drug use,
driving under the influence or exceeding prescribed concentration of alcohol? * Yes No

Any driving offences or issued any speeding or traffic infringements? * Yes No

Fraud, arson, theft or criminal act? * Yes No

Suffered from
any physical or mental disability (excluding eyesight corrected by lenses)? * Yes No

Been declared bankrupt, owned or own a business which has been placed into liquidation or had a receiver or administrator appointed? * Yes No

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