Driver's phone number
Date of birth
Driver's licence number
Owner's phone number
Area of damage to the other vehicle
5. Third Party Details
Estimated cost of damage $
Did the Police attend the collision / theft scene? If No,was the incident reported to Police? If Yes,which Police Station?
7. Police Involvement
6. Witness Details
Who do the Police consider was at fault?
8. Details of the Loss/Damage
Where did the loss / damage occur?
Who do you consider responsible for the loss / damage,and why?
Describe the weather at the time of the loss / damage.
What speed were the vehicles travelling at the time of the loss / damage occurring?