Required fields are marked with an asterisk (*).

Contact Details

First Name *

Last Name *

Address

State

SAVICNSWQLDWATASACTNT

Postcode

Phone

Email *

Message

Did the scam caller refer you to a law firm? *

• Yes
• No

If so, which law firm did they refer you to?

Were vehicles towed from the accident? *

• Yes
• No

Who is your vehicle property damage insurer?

Was the accident reported to South Australia Police online or at a police station? *

• Online
• Police station
• Not reported to police

Did the police attend the accident scene? *

• Yes
• No

Did SA Ambulance attend the scene? *

• Yes
• No

Do you wish to lodge a CTP claim? *

• Yes
• No
• Already lodged a CTP claim

If you have already lodged a CTP claim, which CTP Insurer is it with?

• AAMI
• Allianz
• SGIC
• QBE

Do you consent to the CTP Regulator contacting you about this submission? *

• Yes
• No

Your Enquiry *

Please provide any other relevant information.