Driver Address

Expiry

Driver Address

InsuredComprehensive3rd Party PropertyNot Insured

Offending Driver Address

Expiry

Offending Vehicle Owner Address

Witness Address

Police Station

MVAA LEGAL AUTHORITY TO ACT

PLEASE READ THIS AGREEMENT BEFORE SUBMITTING. BY COMPLETING THIS FORM YOU ARE AUTHORISING MVAA LEGAL TO ACT ON YOUR BEHALF. IF YOU REQUIRE FURTHER ADVICE ABOUT THIS AGREEMENT PLEASE CALL MVAA LEGAL ON 1300 682 200 BEFORE CLICKING THE SUBMIT BUTTON.

I,
as owner/bailee of motor vehicle registration number (the vehicle)
which was damaged in a collision on at (the collision)

appoint (the repairer)

Accident Description

Please click the Accident Diagram section below to download the PDF - you may sketch your accident, photograph the drawing and upload to this form

AUTHORISE MVAA LEGAL TO:
1. Recover on my behalf my claim for repair costs, hire car costs or loss of income and associated losses arising from the collision and I appoint MVAA Legal as my legal practitioners.
2. Negotiate an agreeable settlement for the cost of losses arising from my claim with the repairer and associated service providers (e.g. assessor, rental vehicle provider).
3. Commence legal proceedings (following any necessary advice from MVAA Legal) provided that the repairer and MVAA Legal are responsible for all costs incurred.
4. Direct the offending party and/or the offending party’s insurer to pay all settlement monies arising from my claim to MVAA Legal.
5. Pay the repairer and any other service providers (e.g. assessor, rental vehicle provider) directly for any expenses properly incurred arising from my claim. I AUTHORISE MY REPAIRER:
6. Prepare an estimate of repairs necessary to restore the vehicle to its pre-accident condition (the repairs) and engage a qualified motor vehicle loss assessor to inspect the vehicle and assess the reasonable cost of the repairs.
7. Perform the repairs in accordance with the assessment including subletting any part of the repairs to qualified repairers as necessary.
8. Tow, drive and store the vehicle as necessary for the purposes of the estimation, assessment and performance of the repairs.
9. Act as my agent in their capacity in giving settlement instructions with regards to the costs of repairs they conduct on the vehicle.

I ACKNOWLEDGE:
10. I have consulted with the repairer and have been informed by the repairer where my vehicle will be repaired that they will be responsible for any and all costs, associated with any legal proceedings that may need to be issued to recover the repair costs, hire costs, assessor’s fee and associated losses.
11. I have made the decision not to lodge a claim through my insurance provider, I understand my right to do so and may lodge a claim should I think it is appropriate to do so.
12. I agree to cooperate with MVAA Legal including by signing necessary documents and attending Court if directed and/or required.
13. I have been given the opportunity to seek my own legal advice and/or to contact MVAA Legal to discuss this authority prior to signing.

REPAIRER’S INDEMNITY
14. We agree to unconditionally and irrevocably indemnify you and hold you harmless from all costs, expenses, losses, liabilities, whether direct, indirect, consequential or otherwise, including your legal costs on a full indemnity basis and any costs or obligations to pay any other party’s legal costs on a full indemnity basis on the recovery of rental fees, repair costs and legal costs purportedly owing by you in connection with the collision.

Click here to accept these terms.
Please leave this field empty.
Submit