top of page
ABOUT US
ABOUT US
CONTACT US
HOW IT WORKS
HOW IT WORKS
FAQ
SERVICES
NOT AT FAULT ACCIDENT
1. CAR HIRE
REFER
REFER A FRIEND
REGISTERED REFERRAL
More
Use tab to navigate through the menu items.
APPLY NOW
1300 87 11 85
DECLARATION & AUTHORITY
First Name
Last Name
Date Of Birth
Address
Are you the Owner or Driver of the Vehicle?
Choose an option
Declaration & Authority to Act
I confirm that, to the best of my knowledge, the information I have provided is accurate, complete and not misleading; *
I acknowledge that I have read, understood and agree to IMOK's Privacy Policy; *
I acknowledge that I have read, understood and agree to IMOK's Terms and Conditions; and *
I confirm that I authorise IMOK Accident Replacement Cars (ABN 11 619 986 511 - PO Box 109 Oatlands NSW 2117) to act on my behalf in respect of the recovery of the hire costs and the management of my vehicle repairs. *
Your Signature
Clear
Date
Upload Required Documents
Your Driver's Licence
UPLOAD
Front Side
Your Driver's Licence
UPLOAD
Back Side
Your Vehicle Registration
UPLOAD
Copy of Most Recent Registration
SUBMIT
bottom of page
