• Reference numberYou'll find this in the letter we have sent for the amount owed to us.

You may also need

  • Income detailsDetails of your employment and income
  • Expenses & liability detailsDetails of your living expenses, loans, credit cards, etc.
  • Asset detailsDetails of your properties, vehicles, savings, superannuation, etc.
about 5 - 15 mins

By continuing, you confirm that you have accessed and read the Privacy Policy and Insurance Privacy Collection Notice which contains information on how RACQ Insurance collect, hold, use and disclose your personal information.

Not sure where to find your payment reference number?

 

Your payment reference number can be found in the bottom right of your payment form. Some forms may also have it repeated in the top right.

 

Still don't have a payment reference number?

 

Please contact Insurance Claims on 13 7202

Your name
Your date of birth
Block (Mandatory)
Home address
or, alternatively,

Continue typing...

Manually enter an address

Address
Is this application for a company or business?

How would you like us to reach you?

What is your preferred contact method?
What is your preferred contact method?

Enter your contact details below and select the best option for us if we need to get in touch with you. We'll use your preferred contact method, but may need to call you to discuss the application over the phone.

Should we need to contact you to discuss your application, please select a preferred contact time.

Would you like to nominate a representative for this application?
Postal address
or, alternatively,

Continue typing...

Manually enter an address

Address
Name
Are they a company or business?

How would you like us to reach them?

What is their preferred contact method?
What is their preferred contact method?

Enter their contact details below and select the best option for us if we need to get in touch with them. We'll use the preferred contact method indicated, but may need to call to discuss the application with them over the phone.

To authorise your nominated representative, please either:

  •  Call us on 137 202
  •  Send an Email to claims@racq.com.au, with your claim number in the request
  •  Attach your authorisation now

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How many dependents do you have?
Item
Age of dependent {{data.$i +1}}

Additional support

Do you require any additional support due to the following? Please select all that apply.
Thank you for sharing your circumstances with us.
Tell us about your financial hardship situation and any additional support you may need.
Income
Income
Current income
Assets
Asset

Your living expenses

Mortgage / rent / board
Car finance repayments
Loan repayments
Credit card repayments
Child maintenance
Groceries
Fares / petrol
School fees
Hospital / medical costs
Insurance / superannuation
Rates / water
Gas / power
Phone / internet
Vehicle registration
Other income
How long is left to pay off the loan?
Block (Mandatory)
Will you cancel this card if this application is approved?
Expense amount

Other expenses

Please add any other expenses you have. Include other expenses such as rent-try-buy contracts, which you may not have included in the expenses section above.
Are there any other adults in the household that contribute to expenses?
Do you have any other hardship applications with other credit providers?
Do you intend to declare bankruptcy?
Is any Government Agency, court ruling or financial institution pursuing you for another debt?
Please provide details
Are you seeking alternatives to alleviate your financial situation such as release of superannuation, etc.?
Your details
Claim number
Name
Date of birth
Home address
Postal address
Mobile number
Email address
Nominated representatives details
Name
Company or business name
Mobile number
Email address
Financial summary

This is based on what you have told us your income and expenses are.

Net Income:
Expenses
Your expenses:
Expense contributed by others:
Net expense:
Amount remaining:
Hardship application summary
Current employment
Employment situation
Vulnerability support
Is more information required?
What documents are required?
What other information is required?
Will the applicant provide the requested information by mail?

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Additional information
Has the financial hardship task been manually created in ClaimCenter?
Has the document/requested information received?
Outcome summary
Payment terms
Has the claim updated in ClaimCenter?