Recovery Claim Form

Fill in what you know and tick Don't know for anything you're unsure of. The only thing you must do is sign. Your answers are saved on this device as you go.

Your detailsStep 1 of 6

Who's filling in this form?

Your vehicle

The vehicle that was damaged.

Enter the registration
Enter the make
Enter the model

Owner / registered operator

Enter the owner's full name
Enter the residential address
Enter a contact number
Enter a valid email address
Enter date of birth
Enter licence number
Enter expiry date

Licence & registration

Please attach a copy of the vehicle owner's driver's licence (front and back) and the vehicle's registration papers. On a phone you can take a photo now or choose one from your photos or files.

Driver's licence

Registration papers

Accident details

Enter the date
Enter the approximate time
Enter where it happened
Describe what happened

Accident diagram (optional)

Draw the roads with your finger, then show where each vehicle was and which way it was going. Or, if you've drawn it on paper or have a picture, take a photo or upload it below. You can draw on top of it too.

Photos (optional)

Add photos of the damage, the scene, and the other driver's licence or insurance details if you have them.

At-fault party

Fill in whatever you know, or tick Don't know. A photo of their licence or details is just as good. You can add it in the Photos section.

Check the email address

Third vehicle / witness

Was another vehicle involved, or did anyone see the accident?

Authority to act

  1. I/We hereby authorise Reliance Motor Claims Recovery and its recommended legal representatives to act on my/our behalf in relation to the recovery of losses arising from a motor vehicle collision.
    1. 1.1I/We appoint Reliance Motor Claims Recovery as my/our agent to manage and act on my/our behalf in all matters relating to the motor vehicle collision, including taking any actions deemed necessary to pursue recovery.
    2. 1.2I/We authorise representatives of Reliance Motor Claims Recovery to sign documents on my/our behalf, including but not limited to Repair Authorities, Authorities to Act, and Release Documents.
    3. 1.3I/We authorise Reliance Motor Claims Recovery to instruct and engage recommended legal representatives, including the commencement of legal proceedings where considered necessary.
    4. 1.4I/We authorise Reliance Motor Claims Recovery to execute any documents on my/our behalf in connection with the settlement of the claim.
    5. 1.5I/We grant Reliance Motor Claims Recovery an irrevocable authority to receive settlement payments on my/our behalf into its nominated trust or recovery account and to deduct and disburse any properly incurred costs and expenses before remitting the balance to me/us.
  2. I/We acknowledge that there will be no cost to me/us for the recovery services provided, unless the circumstances of the collision as described by me/us are found to be inaccurate or misleading.
  3. I/We acknowledge that Reliance Motor Claims Recovery provides services as an independent contractor. Nothing in this agreement creates a relationship of employment, partnership, or joint venture.
    1. 3.1To the extent permitted by law, Reliance Motor Claims Recovery shall not be liable for any indirect, incidental, or consequential loss, including but not limited to loss of use, profit, revenue, business, or reputation, or for any delay in the provision of services.

Authority to store, quote & repair vehicle

I, the Vehicle Owner named above, or the authorised agent of the Vehicle Owner, hereby authorise the storage, assessment, quotation, and repair of my vehicle to its pre-accident condition.

I further authorise the arrangement of a loan vehicle if my vehicle is deemed undriveable or uneconomical to repair.

Signature of registered owner / operator

By signing below, you agree to the Authority to Act and the Authority to Store, Quote & Repair above.

Enter your full name
Sign above with your finger or mouse

Please sign before continuing

Date: 15/10/2026

Check your answers

Tap Edit to change anything. When it all looks right, send your signed form to us.

Submit your claim

Your signed claim form and photos will be sent straight to our claims team.