Accident Detail Confirmation V1
The form opened by the Accident Detail Confirmation step, shared across the CC Workflow of most Movement Action claim types.
Claim Type
| Field | Required |
|---|---|
| Claim Type | ✅ |
Driver Details
| Field | Required |
|---|---|
| Driver Phone | |
| Driver Name | |
| Driver Email | |
| Driver Date of Birth | |
| Driver Address | |
| Drivers Licence (Front) | |
| Drivers Licence (Back) | |
| Is Driver the registered owner of the vehicle? | ✅ |
Owner (shown if the driver isn't the registered owner)
| Field | Required |
|---|---|
| Relationship to Owner | |
| Owner Name | ✅ |
| Owner Phone | ✅ |
| Owner Email | ✅ |
| Owner Address | ✅ |
| Owner Licence (Front) | |
| Owner Licence (Back) |
Customer's Vehicle Details
| Field | Required |
|---|---|
| Vehicle Type | |
| Make | |
| Model | |
| Year | |
| Transmission | |
| Registration | ✅ |
| VIN | |
| Registration Type | |
| Do you have Ceramic OR Paint Protection? | |
| Baby Seat Installed? |
Important Details
| Field | Required |
|---|---|
| Customer Registration Papers | |
| Are you Insured? | |
| Is this job a red flag? |
Accident Details
| Field | Required |
|---|---|
| Date of Accident | |
| Time of Accident | |
| Accident Description | |
| Number of vehicles involved? | |
| Accident Location | |
| Damage Description |
At Fault Driver Details
| Field | Required |
|---|---|
| At Fault Name | |
| At Fault Address | |
| At Fault Contact Number | |
| At Fault Driver DOB | |
| At Fault Driver Email | |
| At Fault Rego | |
| At Fault Vehicle Make | |
| At Fault Vehicle Model | |
| At Fault Vehicle Year | |
| At Fault Vehicle Damage | |
| Did the at fault driver admit liability? | |
| How was liability confirmed? | |
| Was liability admitted on a recorded line? | |
| At Fault Party Insurer Name | |
| At Fault Party Insurer | |
| At-Fault Insurance Details | |
| At-Fault Claim# | |
| At Fault Drivers Licence (Front) | |
| At Fault Drivers Licence (Back) | |
| Is the At-Fault driver the owner of the vehicle? |
At Fault Owner (shown if the at-fault driver isn't the owner)
| Field | Required |
|---|---|
| At Fault Owner Name | |
| At Fault Owner Address | |
| At Fault Owner Number | |
| At Fault Owner Licence (Front) | |
| At Fault Owner Licence (Back) |
Sign-Off
| Field | Required |
|---|---|
| I accept the Terms and Conditions and confirm that I have provided true and correct information (checkbox) | ✅ |
| Signature | ✅ |
Related
- Movement Action — the general CC / Loan Car Swap / Delivery / PRI-Recto flow reference
- Rental Only — used only in the CC Workflow