Accident Card

If you are involved in an accident, use this card to record details of the accident to assist you with your insurance claim.

Print this card and keep a copy in the glove compartment of your car.
For a printable version of this card, click here........
Note: You may want to enter your own details in the second and third boxes before you print out the card.

ACCIDENT DETAIL CARD BERT BENNETT Panel Centre 14 Ruse St, Osborne Park. Phone: (08) 9444 4130
ACCIDENT DETAILS
Location of Accident:
Other Details:
Date:		Time:
WITNESS DETAILS
Name:
Address:
Telephone:
DETAILS OF THE OTHER DRIVER INVOLVED
Name:
Address:
Telephone:
Driver's Licence:
Vehicle Registration:
Insurance Company (if known):

HAND YOUR DETAILS TO THE OTHER DRIVER BERT BENNETT Panel Centre - 14 Ruse St, Osborne Park. Phone: (08) 9444 4130
Name:
Address:
Telephone:
Driver's Licence:
Vehicle Registration:
Insurance Company (if known):

HAND YOUR DETAILS TO THE TOW TRUCK DRIVER
BERT BENNETT Panel Centre - 14 Ruse St, Osborne Park. Phone: (08) 9444 4130

Name:

Address:

Telephone:

Driver's Licence:

Vehicle Registration:

Insurance Company (if known):

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