My Motor Claim | Bonus Referral Program | Accident Claims Management

Your Fault – Exclusive Cash Bonus Offer

If the accident was your fault, DON’T PAY EXCESS, we can help you. Our Bonus Referral Program will help you. You just need to refer the other party to us also and we can offer a cash bonus to yourself for bringing us the extra client.

You have two options in lodging the Bonus Referral Program Form with My Motor Claim. Either download the paper form, fill it in and email it back to the email address on the form. Or Fill in the online form below, of which you will also receive a PDF copy to your email address. If you haven’t heard from us within one hour please call us on 9363 8865.

Bonus Referral Claims Form – My Motor Claim Download

Online Form

Your Details (if it was your fault)
Name of Owner of Vehicle (on registration) *

Owner Address *

Phone *

Email *

License Number *
Gender
MaleFemale
Vehicle Details
Year:
Make:
Model:
Registration:
Registered for GST? YesNo
The Drivers Details:
(If the driver is the owner leave details below blank)
Name

Address

Mobile

Email

License Number:
Gender
MaleFemale
OTHER PARTY DETAILS (The other driver)
Name

Address

Mobile

Email

License Number:

Gender
MaleFemale

Vehicle Details
Year:
Make:
Model:
Registration:
Your Insurance Details (At Fault)
Insurance Company:
Claim Number:
ACCIDENT DETAILS
Date of loss/accident:
Approximate time:
Location:
Provide a brief description:
INDEPENDENT WITNESS DETAILS
Full Name:
Contact Number:
Email:
UPLOAD Photos/Documents (if available)
Drivers/Owners License:

I Agree that By completing this form I am authorising My Motor Claim to act on my behalf in relation to a motor vehicle collision. And authorise the Release of Vehicle to the care of my representing agents, My Motor Claim.

Print Name

Date:

Signature (Sign below) with Finger or Mouse

Note: Might have to press Submit button twice. Also if UPLOADING Pics it will take time.

My Motor Claims Team

Darcy

Our expert in the field of motor vehicle claims, Darcy brings years of experience and knows everyone in the industry to deal with your issues efficiently and effectively.

Tatum

Tatum is the best in the field with claims. She has been a consultant fixing motor claims issues for years and is here to help anytime.