Claims Connect

Claims Form

Your Car


Car Owner


Insurance Details

Vehicle Details

Other Details

Other Car

Other Driver

Other Car Owner

Other Driver's Insurance Details

Other Vehicle Details

Additional Information

Place of Accident

Detailed Description of Accident

Diagram of Accident

Use the key below to draw a diagram of the accident and then upload a photo here.

Drop your file here or click here to upload



Police Report


1. I authorise Claims Connect to act on my behalf as an agent.

2. I authorise Claims Connect to send and receive documents such as invoices,quotes and reports in relation to this claim.

3. I authorise Claims Connect to arrange an assessor to substantiate my losses.

4. I authorise Claims Connect to retain a solicitor to act on my behalf if deemed necessary.

5. I acknowledge Claims Connect’s fees and authorise the deduction and payment of these fees once any losses are recovered.

6. I acknowledge that if I withdraw my claim without consent from Claims Connect, I will be responsible for all fees and disbursements.

7. I hereby irrevocably appoint Claims Connect as my agent for the purpose of conducting my claim, including but not limited to settling my claim without reference to me.

Melbourne | Sydney | Brisbane

P: 1800 965 111