Motor Vehicle Claim

We understand it can be stressful when you have a claim, our dedicated Claims team are here to help you and/or your business through this process. Please submit the information on the relevant Claim form and we will contact you shortly.

Should you have any questions, please do not hesitate to contact us on (02) 9868 2199 or via email on claims@brucechiene.com.

Policyholder

Full Name of Policyholder

Address of Policyholder

For what purpose was the vehicle being used?

Insured Vehicle

Vehicle Make

Vehicle Model

Vehicle Registration No

Driver

Name of Driver

Drivers Licence No

Address of Driver

Was the driver under the influence of drugs or alcohol at the time of the accident?

Yes

Accident Date

Date of Accident

Time of Accident

Accident Description

Where did the accident occur?

Describe fully how the accident occured

Was the vehicle towed from the scene of the accident?

Yes

What part of the insured vehicle is damaged?

Other Parties

Number of other vehicles involved

Describe damage to other party's vehicle and/or property

ABN Details

Are you a registered business?

Yes

What is your ABN?