Incident Report Form

Before you fill in this form

If anyone is injured, call 000 first. Then call the Cartrex 24-hour accident line on 0402 157 360 as soon as practicable — within 24 hours of the incident. This form must reach us within 7 days of the accident (or immediately after reporting a theft to police). Do not admit fault or promise to pay anyone — see the declaration at the end of this form.

Your reference for this report — quote it in all follow-up correspondence: Generating…

1 Your rental details

Full name (as on Rental Agreement)

Driver’s licence number

Phone

Rental Agreement / booking reference

Rental Depot

Vehicle registration

Vehicle make, model & colour

Who was driving at the time of the incident? If this person is not You, they must be listed as an Authorised Driver on the Rental Agreement, or Damage Cover may be void under clause 2.

2 Incident details

Date of incident

Approximate time

Exact location (street address / intersection / suburb)

Type of incident

Weather & road conditions

Approximate speed at the time

Accurate written description of how the incident occurred

Diagrammatic description (describe the diagram, and attach a photo of a hand-drawn sketch if possible)

Attach diagram / scene sketch (optional) Files are not sent automatically — see the note at the end of this form on attaching evidence.

3 Injuries

Was anyone injured?

Yes No

4 Police attendance

Police must be notified if anyone was injured, the other party fled the scene without exchanging details, or the other driver appeared to be under the influence of drugs or alcohol — and always in the case of theft.

Did police attend or was a police report made?

Yes No

5 Other party / third party details

Complete for every other driver, vehicle or property owner involved. Leave Third Party 2 blank if not applicable. Your Damage Excess exemption under clause 9.4 depends on these details being complete and accurate.

Third party 1

Full name

Phone

Driver’s licence number

Residential address

Vehicle registration

Insurance company

Policy number

In your view, was this party at fault?

Yes No Unsure

This is your observation only — do not state this to the other party. Fault is determined by Cartrex and/or insurers based on all evidence.

Third party 2 (if applicable)

Full name

Phone

Driver’s licence number

Residential address

Vehicle registration

Insurance company

Policy number

6 Witnesses

Witness 1

Full name

Phone

Address

Witness 2 (if applicable)

Full name

Phone

Address

7 Vehicle damage & evidence

Describe the damage to the Cartrex vehicle

Describe any third-party vehicle or property damage

Photos – Cartrex vehicle damage

Photos – scene, road signs, other vehicle(s)

Photo – other driver’s licence

Other supporting documents

Uploads here are for your own record while completing the form. When you submit, your email app will open with a pre-filled report — please attach these photos to that email before sending, or email them separately to hire@cartrexrentals.com quoting your reference number above.

8 Declaration

I confirm the information in this Incident Report Form is true, complete and accurate to the best of my knowledge, as required by clause 5.1 of the Cartrex Rental Terms & Conditions. I confirm that I have not made, and will not make, any admission of fault, or any offer or promise to pay or settle a claim, in accordance with clause 13.5. I understand a Claims Administration Fee of $220 applies to this claim in addition to any Damage Excess or Single Vehicle Accident Excess, and that these amounts may be charged to my credit card in accordance with clause 9. I agree to cooperate fully with Cartrex’s investigation of this claim and to promptly provide any further information requested, as required by clause 13.4.

Typed signature (full name)

Date

By submitting, your email app will open with this report pre-filled, addressed to Cartrex claims.

Before you fill in this form

Report ready to send