Motor Vehicle Claim Advice Form Page 4
Download a blank fillable Motor Vehicle Claim Advice Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Motor Vehicle Claim Advice Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5Motor Vehicle /
CL AIM ADVI CE FOR M
2. Details of damage to other property:
Owners name and address:
Telephone:
PART K: LIABILITY FOR THE ACCIDENT
1. Did anyone get hurt in the accident?
Yes
No
If ‘Yes’, can you please advise who, their relationship to the driver and known extent of the injuries
3. Who do you consider to be to blame?
3. What are your reasons?
4. Did anyone admit liability?
Yes
No
If ‘Yes’, who:
5. Did the police attend the accident?
Yes
No
If ‘Yes’, please give officer’s name and number:
6. Have the police laid or mentioned laying charges against the driver of your vehicle?
Yes
No
If ‘Yes’, do you know what the charges are likely to be?
PART L: WITNESSES TO THE ACCIDENT
Were there any witnesses?
Yes
No
If ‘Yes’, please give details below:
1. Name:
Passenger:
Yes
No
Address:
Telephone:
2. Name:
Passenger:
Yes
No
Address:
Telephone:
Note: if there is any information you cannot give to us now, please mark the question and let us have it as soon as possible. If there is
not enough room on this form, please attach a separate document.
Is a separate document attached?
Yes
No
PAGE 4
NZI MOTOR VEHICLE Claim Advice Form NZ3403/11 03/15
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal