1300 DAILY RENTAL RATES

(Phone 1300 668 693)

Hire car recovery form

1 Your Vehicle Details

2 Details of the Party at Fault

3 Details of the Accident

Driver
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Business Phone
Home Phone
Fax
Drivers Licence Number
Date of Birth
Date Format: MM slash DD slash YYYY
Email
Is the registered owner also the driver?
- Yes
- No
Vehicle Details
Claim Number
Policy Number
Registration
Owners Insurance Company
Vehicle Model
Vehicle Make
Year

Driver At Fault
Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Business Phone
Home Phone
Fax
Email
Drivers Licence Number
Date of Birth
Date Format: MM slash DD slash YYYY
Is the registered owner also the driver?
- Yes
- No
Vehicle Details
Claim Number
Policy Number
Registration
Owners Insurance Company
Vehicle Model
Vehicle Make
Year

Accident Details
Date
Date Format: MM slash DD slash YYYY
Time

: HH

MM
Suburb
Street
Brief Description of Accident
Name of Witness
Address of Witness
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
H/W Phone
Mobile
Who Admitted Liability to Accident
Police Details
Did the Police Attend?
- Yes
- No
Was a Statement Taken?
- Yes
- No
Name of Police Officer
Police Station
Smash Repair Name
Date hire car required
Date Format: MM slash DD slash YYYY
Declaration
- have read and agreed to the terms and conditions.
By pressing ‘Next’ I: • confirm that, to the best of my knowledge, the information I have provided is true, complete and correct have read, understand and agree to ONYX’s Privacy Policy which contains information about how you can access and correct your personal information, how to make a complaint, and how we deal with complaints. • have read, understood and agree to the Terms and Conditions of Use I authorise Onyx Car Rentals and/or its’ agent to ask for any documents that may be required from the repairer of the damaged vehicle to enable prompt settlement of my charges. I further authorise any cheque or monies received in settlement or payment of my claim against the third party to be utilised and applied to discharge any outstanding charges owed by me to Onyx Car Rentals, or recovery costs incurred by Onyx Car Rentals in respect to any action taken to recover my claim, subject Onyx Car Rentals accounting to me for any surplus. In the event that accounts are not met in full within the credit period I agree that interest will be charged at the highest interest rate permitted by law for each month or part month that they remain outstanding. I understand that in reference to this claim Onyx Car Rentals may have to share my personal details with associated third parties to help settle the claim or for consultation of legal services.
By pressing ‘Submit Form’ I: • confirm that, to the best of my knowledge, the information I have provided is true, complete and correct have read, understand and agree to ONYX’s Privacy Policy which contains information about how you can access and correct your personal information, how to make a complaint, and how we deal with complaints. • have read, understood and agree to the Terms and Conditions of Use I authorise Onyx Car Rentals and/or its’ agent to ask for any documents that may be required from the repairer of the damaged vehicle to enable prompt settlement of my charges. I further authorise any cheque or monies received in settlement or payment of my claim against the third party to be utilised and applied to discharge any outstanding charges owed by me to Onyx Car Rentals, or recovery costs incurred by Onyx Car Rentals in respect to any action taken to recover my claim, subject Onyx Car Rentals accounting to me for any surplus. In the event that accounts are not met in full within the credit period I agree that interest will be charged at the highest interest rate permitted by law for each month or part month that they remain outstanding. I understand that in reference to this claim Onyx Car Rentals may have to share my personal details with associated third parties to help settle the claim or for consultation of legal services.
Signature*
Use your mouse or finger (if on a touch device) to enter your signature.

1300 DAILY RENTAL RATES

(Phone 1300 668 693)

Hire car recovery form

Driver

Vehicle Details

Driver At Fault

Vehicle Details

Accident Details

Police Details

LINKS

ADDRESS

CONTACT