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 quickly and reliably. 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 a 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 would like to proceed with RS Chase Lawyers and claim your full entitlement, please instruct us by filling out the form below.

Please forward this Motor Vehicle Claim Form by any of the following:
Email: info@rschase.com.au
Post: 230 High Street, Preston VIC 3072
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 proceedings;

    - Instructing third parties; and

    - Paying my repairer and incurring disbursements on my behalf. (The client signs this declaration.).

     

    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.