New Claim

Please use this form to lodge a new recovery claim. By lodging this claim you will be appointing Eastside Accident Replacement Vehicles as your agent to provide instructions to a law firm.

It should take about 5 minutes to complete this form. It is recommended that you have all information and documents relating to the collision available, such as:

  • The registration details for your vehicle
  • The details of the other people involved in the collision
  • Photos you might have taken at the scene of the collision

You will be given an opportunity to upload these documents.

Click the 'Next' button to get started.

Your Details

Please enter your contact details. We may need to contact you regarding the collision.

Valid title is required
Please enter your first name
Please enter your last name
Please enter a valid phone number.
Please enter a valid email address
Please enter your address
Please enter your city
Please provide your state
Please enter your postcode

Driver Details

We need to know who was driving your vehicle at the time of the collision.

Please select a title
Please enter the first name of the driver
Please enter the last name of the driver
Please enter a valid phone number.
Please enter a valid email address
Please enter your address
Please enter your city
Please provide your state
Please enter your postcode

Vehicle Details

Please provide us with the details of your vehicle. We need to know if the vehicle was used for business or personal use as this can help us to determine your entitlement to claim GST.

Please enter a valid registration number

Hire Car Details

Did you hire a replacement vehicle after the collision?

Other Vehicles

Please provide as many details about the other vehicles involved in the collision as you can. We must have the Registration Number of the other vehicles.

Please enter a valid number
First Vehicle
Please enter a valid registration number
Second Vehicle
Please enter a valid registration number
Third Vehicle
Please enter a valid registration number
Fourth Vehicle
Please enter a valid registration number
Fifth Vehicle
Please enter a valid registration number

Other Driver's Details

We know it's a hassle, but it's really important that we obtain as many details about the other people involved in the collision as you can provide.

Valid title is required.
Please enter a first name
Please enter a last name
Did this driver lodge a claim on their insurance policy?
Please enter a phone number
Please enter a valid email address
Please enter the address of the other driver
Please provide a valid suburb
Please provide a valid state
Please provide a valid postcode
Valid title is required.
Please enter a first name
Please enter a last name
Did this driver lodge a claim on their insurance policy?
Please enter a phone number
Please enter a valid email address
Please enter the address of the other driver
Please provide a valid suburb
Please provide a valid state
Please provide a valid postcode
Valid title is required.
Please enter a first name
Please enter a last name
Did this driver lodge a claim on their insurance policy?
Please enter a phone number
Please enter a valid email address
Please enter the address of the other driver
Please provide a valid suburb
Please provide a valid state
Please provide a valid postcode
Valid title is required.
Please enter a first name
Please enter a last name
Did this driver lodge a claim on their insurance policy?
Please enter a phone number
Please enter a valid email address
Please enter the address of the other driver
Please provide a valid suburb
Please provide a valid state
Please provide a valid postcode
Valid title is required.
Please enter a first name
Please enter a last name
Did this driver lodge a claim on their insurance policy?
Please enter a phone number
Please enter a valid email address
Please enter the address of the other driver
Please provide a valid suburb
Please provide a valid state
Please provide a valid postcode

Collision Details

Please take the time now to enter as many details about the collision that you can recall. If we need more information we may have to contact you later.

Location of Collision

Enter an address near the area where the collision occurred and click the Find Address button. You can then drag the pin on the map to the exact spot where the collision happened. Use the zoom buttons on the bottom right part of the map to control the zoom distance of the map.

Please select a location
Please enter the date of the collision.
Please enter the time of the collision.
Please enter a description of how the collision happened.

Witness Details

Please enter the details of any witnesses who saw the collision. Despite what you may have heard, it doesn't matter if the witness wasn't independent. It's OK you're related to the witness or otherwise know them.

Please enter a valid number
First Witness
Valid title is required.
Please enter a first name
Please enter a last name
Please enter a valid email address
Please enter the address of the other driver.
Please select a valid suburb.
Please provide a valid state.
Postcode required.
Second Witness
Valid title is required.
Please enter a first name
Please enter a last name
Please enter a valid email address
Please enter the address of the other driver.
Please select a valid suburb.
Please provide a valid state.
Postcode required.
Third Witness
Valid title is required.
Please enter a first name
Please enter a last name
Please enter a valid email address
Please enter the address of the other driver.
Please select a valid suburb.
Please provide a valid state.
Postcode required.
Fourth Witness
Valid title is required.
Please enter a first name
Please enter a last name
Please enter a valid email address
Please enter the address of the other driver.
Please select a valid suburb.
Please provide a valid state.
Postcode required.
Fifth Witness
Valid title is required.
Please enter a first name
Please enter a last name
Please enter a valid email address
Please enter the address of the other driver.
Please select a valid suburb.
Please provide a valid state.
Postcode required.

Upload Documents

This step is optional. We may need to obtain documents from you that are relevant to the collision. Feel free to upload them now.

Please upload any relevant supporting documentation, such as:

  • A photo of your driver's license
  • Photos taken at the scene of the collision (including the other driver's licence)
  • A copy of your certificate of registration
  • Your insurance documents
Files

Select Files

    Agreement

    You're almost done. Please read the below carefully.

    This is important.

    You are about to enter into a binding contract. A record of you agreeing to this contract will be retained by us.

    Please read the below agreement carefully. You should understand that:

    • We may rely on the information you have supplied in this form may be relied on to commence legal proceedings on your behalf.
    • We will do our best not to hassle you about this matter but we may need to contact you to obtain further information.
    • We will need to sign this agreement before it comes into force.
    Type your name in the box above.

    Appointment of Agent and Recovery Agreement

    The parties to this agreement are:

    • of (Customer) or (You)
    • Eastside Accident Replacement Vehicles Pty Ltd (ABN 46 635 491 164) of (Hirer)

    Definitions

    Terms capitalised throughout this Appointment of Agent and Recovery Agreement (the Agreement) are defined as follows:

    "At Fault Party" means any person or entity responsible, including vicariously, for the Collision and the resulting Charges.

    "Charges" means any amount you owe the Hirer or a Related Entity of the Hirer arising out of the Collision.

    "Collision" means the motor vehicle collision involving your Vehicle.

    "Insurer" means any person or entity that has agreed to, or may be called upon to, indemnify any person or entity, including you, for the Charges, or any part thereof.

    "Recovery Claim" means a claim for the recovery of the Charges from the At Fault Party or Insurer.

    "Recovery Firm" means the law firm or mercantile recovery agent the Hirer selects and instructs to prosecute the Recovery Claim on your behalf under clause 3 of the Agreement.

    "Related Entity" has the meaning given in the Corporations Act 2001 (Cth).

    "Vehicle" means your motor vehicle damaged in the Collision.

    Recovery Claim

    1. You are liable to the Hirer for the Charges.

    2. Subject to clauses 10 and 11 of the Agreement, the Hirer will not request payment of the Charges from you while the Recovery Claim is ongoing.

    Our Agency

    1. You appoint the Hirer as your agent to select and instruct a Recovery Firm to pursue the Recovery Claim on your behalf under the terms outlined below. You also give your consent for the Hirer to share your personal and Collision details with the Recovery Firm.

    2. You authorise the Hirer to provide any instructions the Recovery Firm requires in connection with the Recovery Claim, including:

      (a) subject to clause 5 of the Agreement, negotiating the terms, conditions and costs upon which the Recovery Firm will pursue the Recovery Claim;

      (b) providing instructions to the Recovery Firm to negotiate with the At Fault Party or Insurer regarding liability for the Collision and the quantum of the Charges;

      (c) subject to clauses 6 of the Agreement, providing instructions to the Recovery Firm to settle the Recovery Claim on terms and for an amount the Hirer considers to be reasonable; and

      (d) receiving any notices or bills required to be sent to you by the Recovery Firm, and providing any instructions necessary for the receipt, deposit, transfer, or transit of any proceeds from the Recovery Claim, including any interest or legal costs recovered.

    Costs of the Recovery Claim

    1. The Recovery Firm's costs of pursuing the Recovery Claim will be paid from the proceeds of the Recovery Claim, including any interest or legal costs recovered. Should these costs exceed the proceeds, the Hirer will pay the shortfall.

    Payment and Indemnity

    1. If the Hirer provides instructions to the Recovery Firm to settle the Recovery Claim under clause 4(c) of the Agreement, the Hirer will:

      (a) accept any amount recovered from the At Fault Party or Insurer (including any interest or legal costs recovered) in full satisfaction of the Charges; and

      (b) release you from any further liability for the Charges.

    2. Provided you do not breach clause 9, the Hirer will indemnify you in respect to any adverse costs orders that may be made against you in legal proceedings to recover the Charges.

    Your Promises and Obligations

    1. You confirm that you have provided the Hirer with all relevant information and that this information is accurate in every detail. You acknowledge that the Hirer has relied upon the accuracy of this information in agreeing to accept the obligations in clauses 2, 5, 6, and 7 of the Agreement.

    2. You agree that you will co-operate with the Hirer and the Recovery Firm and do all things reasonably required to support the Recovery Claim. This includes providing and signing witness statements or affidavits, appearing in court to give evidence, and providing any information or documents necessary for pursuing the Recovery Claim.

      Termination

    3. The Hirer may terminate the Agreement if you breach your promises or obligations under clauses 8 or 9 of the Agreement, or if the Charges cannot be recovered from the At-Fault Party or Insurer.

    4. If the Hirer terminates the Agreement, you must pay the Charges to the Hirer within 7 days.

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