Service Provider
Your Vehicle Make
Vehicle Purchased From
Replacement Option Card Number:
Details of your vehicle and insurance information
Driver's First Name
Driver's Surname
Date of Birth
Owner's First Name
Owner's Surname
Address
Postcode
Mobile Phone
Home/Business Phone
Email
Owner’s Insurance Company
Policy Number
Claim Number
Vehicle Make
Vehicle Model
Year
Registration Number
Driver’s License No
Expiry Date
Details of the accident
Date of accident
Time of accident
Suburb
Smash Repair
Smash Repair Name
Phone
Fax
Repairs Start Date
Declaration & Authorization
I agree with terms and conditions
Your name
Date
Please prepare: Copies of your Driver License, Registration Certificate and Insurance Policy.
Please email copies to: claims@cmt.net.au
or fax us on: +(612) 9362 1360
or post to:
City Motor Transport
P.O.Box 1301, Double Bay NSW 1360
Phone: Australia Freecall - 1300 887 712