Make a claim 1Introduction2Incident3Your details4Review You can use this form to Make a claim if a Council asset has caused injury or damage to your property or vehicle. To complete this form, tell us your contact details about the incident, including the date and time why you think Council is responsible the amount you are claiming Include photos and documents to support your claim. It will take around 10 minutes to complete this form. After you complete this form we will send you an email to confirm your submission send you a reference number within 10 business days What happens with your information? We record your information on our customer database to give you a better experience, including carrying out and responding to your requests. See our Privacy Statement for more information. What is the reason for your claim? * RequiredPlease selectTrip, slip, fallTree root damageFallen tree/branchBlocked drainRoad condition/damage to vehicleOtherVehicle registration number * Required Vehicle make and model * Required Date * RequiredPlease select date of the incident DD slash MM slash YYYY Time of incident * Required Amount you are claiming * RequiredAddress of the incident * RequiredYou can select a location using the mapZoom in and drag the 'map pin' to select a precise location. If you don't know the exact address of the incident, you can provide an approximate location. How did the incident occur? * RequiredWhy do you think Council is responsible? * RequiredUpload supporting documentsFor example, photos, repair quotes, invoices, receipts or professional reports. You can upload a maximum of 4 files at 4MB each.Allowed file types: jpg, jpeg, png, doc, docx, pdf Drop files here or Select files Accepted file types: jpg, jpeg, png, doc, docx, pdf, Max. file size: 4 MB, Max. files: 4. Maximum file size - 4 mega bytes. 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If you notice errors please use the numbered page navigation or the 'previous' button to make changes. If all information is correct, please click the 'Submit' button to complete this form. {all_fields:exclude[9, 11, 23]}NameThis field is for validation purposes and should be left unchanged.
