Lodge a Claim

Vehicle Details

Owners Details

Driver's Details

Accident Details

Police Details

Did the police attend the scene YesNo

Has the accident been reported to police? YesNo

Details of Third Party:

Is it driveable YesNo

Details of Any Wittnesess:

Things To Remember:

1. The driver and the owner must remain in Australia for the duration of the recovery which includes all court proceedings.

2. The driver and the owner must attend court to provide evidence where liability in regards to the accident is an issue.

3. The owner of the vehicle must ensure that the driver is available for all the court proceeding, where liability for the accident case is an issue. Failure to do so will result in the owner being responsible for all the costs payable to the third party.

4. You must provide accurate information as to the circumstances of the collision. Providing inaccurate and /or misleading information will result in Rideshare Cover Inc not indemnifying the driver and /or the owner. The driver and/or owner will be responsible for all court orders and the costs made against the plaintiff.

Declaration:

To be completed by the driver

I

Do solemnly and sincerely declare that the details and answered queries above are true and correct and promise to assist Calibre Taxi Club in every way in dealing with the claim.

I / We declare that no information has been withheld which may affect the claim.

I/ We confirm that Calibre Taxi Club may at their own discretion instruct any solicitor to act in our common interest in respect of any claim or proceedings as Calibre Taxi Club may consider desirable in our common interest or in Calibre Taxi Club's own interest.

I / We hereby claim indemnity under my / our policy in respect to this accident or loss and authorise the repairer approved by Calibre Taxi Club to carry out repairs and to accept the appointment of any assessor instructed by Calibre Taxi Club.

Date

Driver's Signature

To be completed by the Owner

I

Do solemnly and sincerely declare that

1. The particulars contained in the foregoing claim form relating to the driver are true and correct to the best of my knowledge and belief and promise to assit CTC in every way in dealing with this claim.

2. I / We declare that no information has been withheld which may affect the claim.

I / We confirm that Calibre Taxi Club may at their own discretion instruct any solicitor to act in our common interest in respect of any claim or proceedings as Calibre Taxi Club may consider desirable in our common interest or in Calibre Taxi Club's own interest.