• Iconic Productions / Iconic Performances Pty Limited

    Accident Form - Vehicle

    This form is to be completed by the person (ie: a worker, employee, contractor or approved authorised person, who was the driver at the time of the motor vehicle accident. A separate form (Injury Claim Form) should be completed by any person injured in the accident. A Fatality Claim Form should be completed by a person who is claiming compensation as a result of a person’s death in a motor vehicle accident. This form must be lodged with the approved company insurer of your vehicle. If you have any queries, please speak with your office’s vehicle transport manager or the Company Director.
  • Being involved in an accident can be a very traumatic experience.  If you are involved in a vehicle accident it is imperative that you do the following.

    1. Stay calm and contact your Emergency Department Phone (Australia is 000 / USA is 911 / UK is 999)

    2. Contact your Supervisor and inform them of the accident.

    3. Switch off the engine and remove the key from the vehicle

    4. Do not move the cars, unless told to do so by the police.  Tow Truck Drivers do not have the authority to manage accidents or inform any person to move the vehicles.  The vehicle/s must remain exactly where the accident occurred until police arrive or details have been exchanged and photos have been taken.  This is very important for the assessment of the insurance.  Moving the vehicles can make you liable for the accident if you have not been instructed to by a police officer.
      1. If involved in any type of accident, you should always take a photo of all the vehicles (wide shot) involved in the accident.
      2. It is not a photo of just Iconic's vehicle in a wide shot that is needed.
      3. When involved in an accident,
        1. do not move any of the vehicles from the point of impact until all details are exchanged and all photos are taken. This is important to prevent a drive-off by the other drivers and to obtain proof of the point of impact of all vehicles to verify what you have stated in your accident form. Without a wide shot of the accident of all vehicles/property, there is no proof and you could be responsible and liable.
        2. Take a photo or video of the license plate (vehicle registration place) and upload that on the accident form for evidence.
        3. Then proceed to obtain all the required details of all drivers involved as listed in the next point:

    5. Obtain the following details from all the other drivers involved and of the other party and if there are multiple vehicles then of all the involved parties.
      1. The Full name (first and last/surname).

      2. A photo of the front and back of their driver's license.  It has to be a photo.  Do not accept a written paper from them.

      3. Contact telephone number (preferably their cellphone/mobile number of the other persons.

      4. Email address of all persons involved.

      5. The Address of the other persons involved, if not on the license.

      6. The Insurance Company they are with and the Type of Insurance if they recall.

      7. A photo of the registration (license) plate of all the other vehicles involved. It has to be a photo.

      8. A photo of Iconic's vehicle and all the other cars or property involved.
        1. Take multiple photos, wide, close up and medium shots.

      9. The make and model of all vehicles or property involved in the accident.

    6. Do not provide, offer or accept responsibility or blame for the accident. 

    7. Find a safe place off the street on the kerbside and then proceed to complete the accident form and/or obtain the details required in the below point.

    8. When all driver details are exchanged and all photos are taken, only now is the safest time to proceed to the next steps of completing the accident form.

    REMEMBER: You may not be a trained mechanic or vehicle technician it is important to remember safety always first. If a vehicle is involved in an accident you do not know what leaks or damages are being done or have been done to the vehicle at the time of the accident. If there was a leak and you start the engine of the vehicle, how do you know that you won't cause an explosion? You don't. So remember when involved in an accident, DO NOT MOVE THE VEHICLES from the point of the accident until all details are exchanged, all photos are taken and it is safe to do so.

    If the other people want to move the vehicles you can't stop them, but you should start taking pictures immediately and tell them that it is not safe to do that right now and the first the details should be exchanged and photos taken. Also, this is a safe thing because it means they cannot drive off and if other cars pass by they could be witnesses to the accident or drive off with their own dashcams.

    The form should be completed within the first 1 hour of the accident and should not be done overnight or the next day.



  • Date of Accident*
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  • DESCRIPTION OF ACCIDENT / VEHICLE or PROPERTY DETAILS

  • 0/500
  • Were there other vehicles involved other than the Iconic Company Vehicle or Rental Vehicle?*
  • Upload Photo of LICENSE PLATE of other vehicle/s
    Cancelof
  • Upload Wide Shot
    Cancelof
  • Upload Iconic Vehicle Damage
    Cancelof
  • Upload photo of OTHER VEHICLE and or PROPERTY
    Cancelof
  • ROAD CONDITIONS

    Answer the questions based at the time of the accident.
  • The Road was at the time of the accident ... (you can select more than one).*
  • The traffic at the time of the accident was ...*

  • Traffic Controls at the time was ...*

  • The weather was ...*

  • The lighting condition was ...*
  • SPEED and conditions of VEHICLES

  • DRIVERS / PASSENGERS / PERSONS

    This section is about the drivers, persons or passengers that were involved. Where you are not able to answer a question write n/a
  • Upload Driver's Licenses
    Cancelof
  • Upload copy of Breathalyser or Drug Test
    Cancelof
  • POLICE DETAILS

    Answer questions based at / during the accident
  • Did the police attend the scene of the accident?*
  • INDEPENDENT WITNESSES

    Answer questions based at / during the accident
  • Were there any independent witnesses?*
  • 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.

  • Date of Signature*
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  • Should be Empty: