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I’ve had an Accident

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I’ve had an Accident

In the event of an accident

If there is any injury, call emergency services on 111 immediately
NO NOT admit liability to any person
Report the accident to OnRoad Rentals on 0800736863 or info@onroad.co.nz immediately
If you are unable to drive the vehicle safely, contact AA Roadside Assistance on 0800525525

Ive had an Accident

Your Rental Agreement Number *

Your Vehicle Registration Number *

Your Name *

Where were you heading from and to? *

Did you consume any alcohol in the 12 hours prior to the accident? *

Yes

No

Did you undergo a blood or breath test? *

Yes

No

Have you been involved in any other accident in the past 5 years *

Yes (please provide details)

No

Have you received any traffic offences (other than speeding) in the last 5 years? *

Yes (please provide details)

No

Details of damage to the OnRoad Rentals vehicle *

Did the accident involve any other vehicle or property? (If yes, please get their details below) *

Yes

No

Registration Number

Make & Model of Vehicle

Insurance Company

Their Name

Their Address

Their Email Address

Their Phone Number

Their Licence Number

Nature of damage to third party vehicle/property

Accident Details - What Happened? *

Where did the accident happen? Street names etc. *

What date did the accident happen?

What time did the accident happen? *

What speed were you travelling at the time of the accident? *

Weather/Road conditions? *

Dry

Wet

Fog

Ice

Snow

Was the road sealed? *

Yes

No

Did Police attend the accident? *

Yes (please provide officers name)

No

In your opinion, who is responsible for the accident and why?

By ticking this box, you declare that to the best of your knowledge, the answers provided in this form are truthful and that the information here can be transposed to an insurance claim form

Yes

Please leave this blank

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0800 RENTME

info@onroad.co.nz

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