04 560 4755
Vehicles
Services
Accident Rentals
Accident Rentals
Accident FAQ
Application Form
FAQ
Terms
About
Contact
04 560 4755
Accident Replacement Rental Vehicles
Insurance Application Form
Your details
Insurance claim number
First name
*
Last name
*
Phone number
*
Email
*
Home address
*
Driver licence number
*
Vehicle registration
*
Insurance company
AA Insurance
AMI Insurance (IAG)
AMP Insurance (Vero)
Ando Insurance
ANZ insurance (Vero)
ASB insurance (IAG premier care)
Autosure Insurance (Vero)
BNZ insurance (IAG premier care)
Clubauto Insurance
Co-operative bank insurance (IAG premier care)
Cove Insurance
FMG Insurance
Insure Direct
Janssen Insurance
Kiwibank insurance (Ando insurance rental benefit conditions)
Lantern Insurance (IAG)
MAS Insurance
NZI Insurance (IAG)
Protecta Insurance
Provident Insurance
QBE Insurance
Quest Insurance
Star Insurance
State Insurance (IAG)
Swann Insurance (IAG)
Tower Insurance/Trade Me Insurance
Toyota Insurance
TSB insurance (Tower insurance rental benefit conditions)
Vero Insurance
Westpac/Lumley (IAG)
Zurich Insurance
Other
Insurance company
Other Insurance Company
Other driver details
Section
First name
Last name
Phone number
Email
Home address
Driver licence number
Vehicle registration
Insurance company
AA Insurance
AMI Insurance (IAG)
AMP Insurance (Vero)
Ando Insurance
ANZ insurance (Vero)
ASB insurance (IAG premier care)
Autosure Insurance (Vero)
BNZ insurance (IAG premier care)
Clubauto Insurance
Co-operative bank insurance (IAG premier care)
Cove Insurance
FMG Insurance
Insure Direct
Janssen Insurance
Kiwibank insurance (Ando insurance rental benefit conditions)
Lantern Insurance (IAG)
MAS Insurance
NZI Insurance (IAG)
Protecta Insurance
Provident Insurance
QBE Insurance
Quest Insurance
Star Insurance
State Insurance (IAG)
Swann Insurance (IAG)
Tower Insurance/Trade Me Insurance
Toyota Insurance
TSB insurance (Tower insurance rental benefit conditions)
Vero Insurance
Westpac/Lumley (IAG)
Zurich Insurance
Other
Insurance company
Other Insurance Company
Insurance claim number
Details of the incident
Section
Who was at-fault?
*
Me
Other driver
Location of accident
*
Circumstances/details of the accident
*
Add Another Witness
Witness name
Witness phone number
plus1
Add Another Witness
minus1
Remove
Your Accident Replacement Rental Vehicle
Section
Small car
Medium car
SUV
7-seater
8-seater
Passenger van
Ute
Cargo van (medium)
Cargo van (large)
Crew cab truck
Disability van
Where would you like the Accident Replacement Rental Vehicle dropped off?
*
Home address (as above)
Panel beater
Other
Panel beater company
*
Panel beater address
*
Please upload photos of the accident scene
Drop a file here or click to upload
Choose File
Maximum file size: 5MB
Max 10 photos
Captcha
If you are human, leave this field blank.
Submit