Vehicle Repair Declaration Vehicle Repair DeclarationDate DD slash MM slash YYYY To (Insurer) From (Repairer) Vehicle Owner Make Model Claim No Rego Process of RepairingDate of Arrival DD slash MM slash YYYY Arrival Type Drive-In Tow In Drivable Yes No Dismantled Yes No Damage DescriptionEstimate Date DD slash MM slash YYYY Estimate Sent to Insurer On DD slash MM slash YYYY Assesment Insurer Assesment Date DD slash MM slash YYYY Parts Order Date DD slash MM slash YYYY Parts Arrival Date DD slash MM slash YYYY Back Ordered Parts Backorder Arrival Date (1) DD slash MM slash YYYY Backorder Arrival Date (2) DD slash MM slash YYYY Sublet Date DD slash MM slash YYYY Sublet Type Mechanic Dealership Other Sublet DescriptionSublet Return Date (1) DD slash MM slash YYYY Sublet Return Date (2) DD slash MM slash YYYY Completion Date DD slash MM slash YYYY Total Repair Days Reason for delay if not completed on schedule Declaration I hereby declare that the above information is a true account of the sequence of events that occurred in the process of repairing the above vehicle. I authorise Carbiz Rentals to disclose this information to third parties such as other insurers, reinsurers, loss adjusters, external claim data collectors, investigators and agents, or other parties as required in their effort to recover costs related to the provision of accident replacement vehicles. eSigned Date DD slash MM slash YYYY Signature IDPhoneThis field is for validation purposes and should be left unchanged.
