Acknowledgement and Declaration
The Questions and Form Fields in this accident report form requesting information as to fault are not required by statute and do not require you to assess who is at fault as a matter of law. You are requested to provide this information simply to assist with initial administration of the claims process. It is important that you do not attempt to lay blame or fault to any person in any of your answers to this accident and answer with truth and honesty from the information you know.
Any information provided on this form as to fault is indicative only and cannot constitute an admission of fault or wrongdoing by any person for legal purposes. Under the Motor Vehicles Act 1959 (MV Act) an accident caused by or arising out of the use of, a motor vehicle that results in the death of, or bodily
injury to, any person, must be notified in writing to the insurer who provides CTP insurance for that vehicle.
This form contains the information required under the MV Act and additional information requested for administrative purposes. If you do not provide all of the information set out in this form, and you are the driver, owner or person who was in control of the vehicle at the time of the accident, you may be
guilty of an offence under the MV Act, punishable by a penalty of up to $1,250 or imprisonment for up to 3 months.
Personal information (including sensitive information) collected in this form and throughout the course of any subsequent insurance claim will be collected and handled for the purpose of managing, assessing and investigating any such claim, to handle associated complaints and disputes, associated business activities and detecting fraud.
By completing this form you consent to your personal information being collected and handled for the purposes above, in accordance with the MV Act, the Insurance Regulation Act 2016, this privacy statement and as otherwise authorised or required by law. Your consent also covers the collection of personal information (including sensitive information) from you and as otherwise required or authorised by law.
Your personal information may be disclosed between the approved insurer, the CTPI Regulator, the Nominal Defendant, other approved insurers, and other government agencies and third parties involved in the assessment of any claim related to the accident described in this form (including those described in the Authority on this form), and as otherwise authorised or required by law.
Each of these parties will collect and handle this information (including all personal information and sensitive information) for the same purposes set out above.
The privacy policy of each approved insurer contains information about how you may access the personal information the insurer holds about you, how you may complain about a breach of the Australian Privacy Principles by the insurer and how they will handle a complaint. The name and contact details for privacy enquiries for each insurer who provides insurance in the state and country jurisdiction of the Head Office of the Company is set out on each insurers website.