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Name
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Number
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Vehicle
Make
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Model
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Year
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Vin
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Vehical Colour
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Register Number
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Description
Insurance
Is this being paid by insurance?*
YES
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Please select My Insurance / Third Party Insurance company name
AAMI
AI Insurance
Allianz
ANZ
Australian Unity
Bendigo Bank
Bingle
Budget Direct
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QBE
Clam Number
If going through insurance, do you have hire car coverage? Please select Yes / No
YES
NO
Profile
Front on image of vehicle showing registration plates:
Rear image of vehicle showing registration plates:
Registration sticker (must be able to read details):
VIN plate ñ consult owners manual for location (must be able to read details):
Corner from impact direction:
Opposite corner from impact direction:
Non-impact corner of vehicle:
Opposite non-impact corner of vehicle:
Close up photo of damage:
Alternate angle close up:
Remainder of panel:
Opposite side to damage:
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