Online claim lodgement form

Personal details

Accident deails

Information

Injury details

Financial details

Personal Details

Step 1

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Welcome

Please use this form to make a TAC claim online. You must complete all questions marked with an asterisk *.

If we need more details as you complete the form we will let you know.

Please select who is completing this form *

As you are completing this form on someone elses behalf, please supply your details below so we can contact you if required Person Filling in form - Surname

Person Filling in form - First name

Person Filling in form - Contact Number

You mentioned you are a solicitor please specify your Organisation

Please complete the rest of the form from the person making the claims point of view

Title *

Surname *

First name *

Date of Birth *

Gender *

Male
Female

This field is required.

Residential address *

Postal address (if different to residential)

Mobile phone number *

This field is required.

Alternate phone number

Email address *

Do you require an interpreter?

Language required

Please outline the details of the accident in your words *

Your privacy

The TAC respects your privacy. The TAC will retain this information and may use or disclose it to make further inquiries or assist in the ongoing management of the claim. The TAC may also be required by law to disclose this information.
If you require further information about our privacy policy, please call the TAC on 1300 654 329 or visit our privacy policy.