IPS Online Motor Claim Form

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IPS Online Motor Claim Form

Welcome to IPS Online Motor Claim Form and Lodgement Service.

This service has been designed to ensure the speedy lodgement and settlement of your claim.
(Please note that the form is not suitable for all motor insurance policies however, an alternative process will be available to you once you commence completing the form)

If at any time you are unsure as to what details are required or have any queries with regards to the claims process please do not hesitate to contact our friendly staff on 08 9340 5400.

Name of Policyholder

Policy Number

Name of insurance Company

Your Contact Name

Your Telephone Number

Your Email Address

Are you registered for GST?

ABN

VEHICLE DETAILS

Year

Make

Model

Body Type

Accessories

If any finance on vehicle - Name of Finance Company

DRIVER DETAILS

Name

Address

Contact Number

Licence Number

Expiry Date

Year Licensed

Date of Birth

Was this vehicle being used with the insured's knowledge?

DISCLOSURE QUESTIONS

Has the insured ever made a claim under a motor vehicle policy or been convicted of any offence from the use of a motor vehicle?

Details

Had the driver consumed any intoxicating liquor or taken any drugs during 12 hours prior to accident?

Details

Has the driver had any insurance or renewal declined or cancelled or special conditions imposed within the last 5 years?

Details

ACCIDENT DETAILS

Date of Accident

Time

Location

Description

Who do you consider responsible for the accident?

Did either party admit liability?

THE OTHER VEHICLE/PROPERTY

Name

Address

Contact Number

Licence Number

Vehicle Registration Number

Make/Model of Vehicle

Insurance Company

Policy Number

If Other Parties Involved: please provide details (as per the above)

WITNESSES

Name

Address

Telephone Number

Would you like to add another witness?

Name

Address

Telephone Number

HAVE THE POLICE BEEN NOTIFIED?

(For damages totalling over $3,000 for all parties this is a legal requirement)

Did a Police Officer attend the accident?

Name of the Police Office

Police Station

Please provide details if there were any charges laid against any parties

Was an online report done?

Online Report Number

DAMAGE TO YOUR VEHICLE

Was your vehicle damaged?

Details

Have you obtained a quote?

Please attach your quote

Would you like us to give you details of the nearest preferred repaired?

Registration Number

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Contact info

Phone: (08) 9340 5400
Fax: (08) 9340 5411
Email: reception@theipsgroup.com.au
Suite 6-8 (first floor)
134 Main St
Osborne Park WA 6017

PO Box 197
Osborne Park WA 6917