Apply Now

"*" indicates required fields

Apply Now

Complete the form and we will call you to confirm approval.

1. Your Details

Name*

First Last

Phone*

Email*

Address

Occupation

Date of Birth*

Class of Licence

Licence Number*

Licence Expiry

Vehicle Registration*

Vehicle Make*

Vehicle Model*

Vehicle Mode*

Vehicle Year*

Do you have insurance on your vehicle?

Yes

Insurance Company

Type of Cover

Claim Number

Are you claiming on your policy or against the at fault party?

Your Policy

At Fault’s Policy

Do you require any additional accessories or tools?

Canopy

Ladder Rack

Lock-Up Toolbox

Roof Rack

Tow Bar

Forward & Rear Facing Baby Seats

Booster Seats

Subject to availability.

2. Accident Details

Date of Accident*

Time of Accident*

Weather

Address*

Is your vehicle legally drivable?*

Yes

Date Vehicle Required*

How many vehicles were involved?*

What happened in the accident?*

Where on the vehicle was the vehicle damaged?*

Witness Details

Were there any independent witnesses?*

Yes

Witness Name

Witness Phone

Witness Email

Witness Address

Did police attend the scene?*

Yes

Police Station

Officer Name

Police Event Number

Repairer Details

Which repairer are you using?*

Estimated days to repair

3. At Fault Party Details

At Fault Personal Details

Name*

Phone*

Licence Number

Address

At Fault Vehicle Details

Vehicle Rego

Vehicle Make

Vehicle Model

At Fault Insurance Details

Insurance Company

Type of Cover

Claim Number

4. Final Details

Is your vehicle registered for GST?

Yes

ABN Number

Does anyone else drive your vehicle regularly?

Yes

Additional Driver Name

Additional Driver Phone

Additional Driver Licence Number

How did you hear about us?

Additional Information

If you have them readily available please upload your driving licence, any images of the damage and your registration papers to enable us to speed up the process of reviewing your application.

Attach Licence Pictures Here

Max. file size: 2 MB.

Attach Supporting Documents Here

Max. file size: 2 MB.

Terms and Conditions*

I have read, understood and accept Compass Corp’s Privacy Policy.

I have read, understood and accept Compass Corp’s Terms and Conditions, Mandate and Authority to Act.

Captcha

Comments

This field is for validation purposes and should be left unchanged.

Request a Callback

Allow Cookies

Our website uses cookies to ensure you get the best experience on our website.