Stella Motor Claim Form

For Comprehensive and Third Party Property Damage Policies

SECTION 1 - POLICYHOLDER DETAILS

Policyholder Name *

Policy Number *

Date of Birth *

Residential Address *

Street AddressStreet Address line 2

City

State

Postcode

Phone Number *

Email Address *

Preferred Contact Method *

PhoneEmail

Are you the policyholder? *

YesNo

If no, state your name and relationship *

SECTION 2 - VEHICLE DETAILS

Make *

Model *

Year *

Registration Number *

Is the vehicle financed? *

YesNo

Financer Name *

Loan Account Number *

Proof of Ownership Provided? *

YesNo

List any accessories or modifications (as defined in the PDS) *

Was the vehicle roadworthy at the time of the incident? *

YesNo

SECTION 3 - DRIVER DETAILS (AT TIME OF INCIDENT)

Driver Name *

Driver Date of Birth *

Relationship to Policyholder *

Is the driver listed on the policy? *

YesNo

Driver's Licence Number

State of Issue

Licence Class

Years Licensed

At the time of the incident, was the driver:

Under the influence of alcohol/drugs? *

YesNo

Using a mobile phone? *

YesNo

Legally permitted to drive the vehicle? *

YesNo

SECTION 4 - INCIDENT DETAILS

Date of Incident *

Time of Incident

Exact Location of Incident *

Describe what happened (full narrative) *

Weather Conditions *

Road Conditions *

Was the vehicle drivable after the incident? *

YesNo

Was Towing required? *

YesNo

Was the vehicle stolen or vandalised? *

YesNo

Was the vehicle being used for business, rideshare, delivery, or any excluded purpose? *

YesNo

Was the vehicle locked and were keys secured? (Theft claims) *

YesNoN/A

SECTION 5 - THIRD PARTY DETAILS (IF APPLICABLE)

Other Driver's Name

Address

Phone Number

Vehicle Registration

Vehicle Make/Model

Insurance Company

Policy Number

Any witnesses?

YesNo

Name

Phone

Name

Phone

SECTION 6 - POLICE / EMERGENCY SERVICES

Was the incident reported to police? *

YesNo

Police Report Number

Officer Name / Station

Police Event Number

Police Constable in Attendance

Police Station Reported To

For theft: Was the theft reported immediately? *

YesNoN/A

SECTION 7 - DAMAGE DETAILS

Describe the damage to your vehicle *

Photos Provided *

YesNo

Dashcam Footage Available *

YesNo

CCTV Footage Available *

YesNo

Were emergency repairs completed? *

YesNo

If yes, attach receipts below.

Emergency Repair Receipts

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Upload receipts for any emergency repairs completed.

Current Location of Vehicle *

Location Details

SECTION 8 - TOWING AND STORAGE

Tow Provider Name

Tow Provider Phone Number

Tow Provider Email

Tow Destination

Were towing/storage receipts provided? *

YesNo

Was TrueCover notified before storage fees accrued? *

YesNo

SECTION 9 - HIRE CAR DETAILS

Was a Hire Car used? *

YesNo

Hire Car Provider Name *

Hire Car Provider Phone Number

Hire Car Provider Email Address

Hire Car Reference Number *

Dates of Hire

Receipts Attached *

YesNo

Reason for hire *

TheftOptional Hire Car CoverOther

Other reason (please specify)

SECTION 10 - CAR CONTENTS CLAIM (IF APPLICABLE)

List of items lost/damaged (max $2,000)

Proof of ownership provided? *

YesNoN/A

Police Incident Number (for theft)

Was the vehicle locked at the time? *

YesNoN/A

SECTION 11 - WINDSCREEN CLAIM

Type of Damage *

RepairReplacementN/A

Photos Provided *

YesNoN/A

Calibration Required *

YesNoN/A

Repairer Details

SECTION 12 - SUPPORTING DOCUMENTS CHECKLIST

Upload Supporting Documents

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Upload all supporting documents here (photos, reports, receipts, etc.).

SECTION 13 - DECLARATION

I declare that the information provided in this claim form is true and correct. I understand that providing false or misleading information may result in denial of my claim.

Declaration *

Signature *

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Your Name *

Date *

Please complete the verification below. *

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