RS Chase Lawyers

ONLINE FORMS

MOTOR VEHICLE CLAIM FORM

By completing this form you are authorising RS Chase Lawyers to act on your behalf
in relation to a motor vehicle collision

If you have had an accident and you believe you are not at fault and/or the at-fault party’s insurer is making your life difficult – RS Chase Lawyers
can help you claim your full entitlement from the at-fault driver or their insurer that is fast, reliable and effective.

To ensure that you minimise the financial harm suffered as a result of a collision, we instruct independent loss assessors to determine the amount
of damage you have suffered and whether your car is write-off.

RS Chase Lawyers will also assess your entitlement to a hire car, loss of income, stamp duty, tow truck invoice, storage charges,
and loss of personal items.

At RS Chase Lawyers, if you are not at fault, we try to ensure that you do not have out of pocket legal expenses (often this is the case) – However,
any legal expenses are kept to a minimum.

IF YOU WANT TO PROCEED WITH RS CHASE LAWYERS AND CLAIM YOUR FULL ENTITLEMENT, INSTRUCT US BY FILLING OUT THE FORM BELLOW.

Please forward this Motor Vehicle Claim Form by any of the following :

Email : info@rschase.com.au
Fax : 03 9481 4342
Post & Hand delivery : 464 High Street Northcote VIC 3070

If you have any queries, please call 03 9481 6464 to discuss

Motor Vehicle Claim Form

Please provide names, addresses and telephone numbers of any passengers and independent witnesses :

At Fault
Third Party Details
Further Details if different from above
Vehicle
Accident Details


hereby instruct RS Chase Lawyers to act on my behalf in relation to the collision described on this form including :
- Corresponding with relevant parties ;
- Issuing and litigating proceeding;
- Instructing third parties ; and
- Instructing third parties, paying your repairer and incurring disbursements on your behalf.

I acknowledge that RS Chase Lawyers is reliant upon the information supplied by me and that if I do not update my contact details,
they may consider themselves no longer instructed by me.