Fillable Written-O Vehicle Notication Form (Services Australia)

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Written-O Vehicle Notication Form (Services Australia)

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The Written-O Vehicle Notication Form (Services Australia) form is 17 pages long and contains:

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  • 66 check-boxes
  • 558 other fields

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File type: PDF

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When blank, this form is classed as OFFICIAL, when completed, this form is classed as OFFICIAL SENSITIVE
Complete this form and return to Department of Transport - Vehicle Services
Email: WOVR@transport.wa.gov.au
Mail: Driver and Vehicle Services - Vehicle Services, GPO Box R1290, Perth, Western Australia 6844
Enquires: 1300 224 090
All elds marked with an * are mandatory.
DETAILS OF NOTIFIER
OTHER DETAILS
REFERENCE NUMBER*
TYPE OF NOTIFIER* (tick one)
AUTO-DISMANTLER
DEALER
OTHER (please specify below)
ASSESSOR
AUCTION HOUSE
INSURER
IS NOTIFICATION BY ASSESSOR*
DETAILS OF ASSESSOR MAKING DECLARATION
Last updated: 08.03.2021
BUSINESS / COMPANY NAME*
YES (Proceed to section: Details of assessor making declaration)
NO
(Provide notier’s details below and then proceed to section: Details of assessor making
declaration)
NOTIFIER’S OTHER NAME(S)
NOTIFIER’S FAMILY NAME
NOTIFIER’S FIRST NAME (Leave blank if you have a single name)
OTHER NAME(S)
ASSESSOR NUMBER
FAMILY NAME*
FIRST NAME* (Leave blank if you have a single name)
PHONE NUMBER*
FAX NUMBER
EMAIL ADDRESS*
INSURANCE CLAIM NUMBER*
NO INSURANCE DETAILS AVAILABLE
VEHICLE MAKE*
VEHICLE MODEL*
VIN* (17 Characters)
DETAILS OF VEHICLE AND OWNER
VEHICLE TYPE*
CARAVAN
TRAILER
MOTOR VEHICLE
MOTORCYCLE
PLATE NUMBER*
STATE / TERRITORY*
YEAR OF MANUFACTURE*
COMPLIANCE DATE*
/
NO PLATE
AVAILABLE
Alphanumeric, not in (I,O,Q) Numbers only
NON-STANDARD VIN FORMAT
ENGINE NUMBER
Alphanumeric, not in (I,O,Q), min, 12 characters
OWNER’S FULL NAME*
DETAILS OF ASSESSOR CONTINUED
RESIDENTIAL ADDRESS*
SUBMIT
BUSINESS ADDRESS*
STATE POST CODE
SUBURB
STATE POST CODE
SUBURB
Government of Western Australia
Department of Transport
WOVR1
Written-O Vehicle Notification Form
Road Trac (Vehicles) Regulations 2014
DETAILS OF VEHICLE AND OWNER CONT. DETAILS OF INCIDENT
Repairable write-o Statutory write-o
INCIDENT DATE*
/ /
WRITE-OFF TYPE*
ODOMETER READING
DATE OF INCIDENT
IS UNKNOWN
WRITE-OFF DATE* / DATE WRITE-OFF DECISION MADE
/ /
LATE NOTICE REASON
(Must provide late notice reason if the notication > 7 days since write-o date)
INCIDENT DAMAGE / SEVERITY
(up to two incident types may be recorded)
INCIDENT TYPE ALLOWABLE DAMAGE / SEVERITY CODE(S)
(I) - Impact
A - Heavy panel (replace panels)
B - Light panel (repairable, traditional or
paintless)
C - Heavy structural (buckle, cut, cracked, folded,
fractured)
D - Light structural
E - Unrepairable (permitted locations - Restraints
/ Whole Veh only)
F - Major mechanical damage
G - Minor mechanical damage
(M) - Malicious /
Vandalism / Stripping
E - Unrepairable (permitted locations - Restraints
/ Whole Veh only)
H - Major stripping (interior parts, external
panels)
I - Minor stripping (wheels, radio, damaged locks)
J - Major vandalism (interior parts, external
panels)
K - Minor vandalism (wheels, radio, damaged
locks)
(W) - Water (salt or
fresh)
L - Water (salt)
M - Water (fresh)
(F) - Fire
E - Unrepairable (permitted locations - Restraints
/ Whole Vehicle only)
N - Burnt / blistered
O - Smoke and heat (minor engine / interior re /
exterior heat)
P - Minor smoke (smoke and / or soot damage to
the interior)
(H) - Hail
A - Heavy panel (replace panels)
B - Light panel (repairable, traditional or paint-
less)
(D) - Dismantled
H - Major stripping (interior parts, external
panels)
The damage reporting templates that follow will restrict the choice of Damage
/ Severity based on the Incident Type selected, detailed in the table below:
The damage reporting template that follow for a maximum of two incidents;
restrictions apply. The allowable combinations are shown below:
PRIMARY INCIDENT TYPE
ALLOWABLE SECONDARY INCIDENT
TYPE
(I) - Impact F-Fire, M-Malicious, W-Water, H-Hail,
D-Dismantled
(M) - Malicious / Vandalism /
Stripping
I-Impact, F-Fire, W-Water, D-Dismantled
(W) - Water (salt or fresh) I-Impact, H-Hail, D-Dismantled
(F) - Fire I-Impact, M-Malicious, W-Water,
D-Dismantled
(H) - Hail F-Fire, M-Malicious, W-Water,
D-Dismantled
(D) - Dismantled None
OWNER’S ADDRESS*
STATE POST CODE
SUBURB
RECORD DAMAGE DETAILS FOR MOTOR VEHICLE
A full description of the national damage assessment criteria for passenger and light commercial vehicles and how to apply them is set out in the publication
Damage Assessment Criteria for the Classication of Statutory Write-Os (2019) published by the National Motor Vehicle Theft Reduction Council and Austroads.
A PDF version of the publication can be downloaded from carsafe.com.au or austroads.com.au
14 Whole vehicle
15 Floor pan (passenger front)
16 Fire wall
17 Chassis/structural rails (passenger)
18 Floor pan (driver rear)
19 Floor pan (driver front)
20 Floor pan (passenger rear)
35 Suspension (driver front)
36 Suspension (passenger rear)
37 Suspension (driver rear)
38 Airbag front
39 Airbag side
40 Airbag curtain
41 Seat belt pre-tensioner
21 Chassis/structural rails (driver)
22 A pillar passenger
23 A pillar driver
24 B pillar passenger
25 B pillar driver
26 C pillar passenger
27 C pillar driver
28 D pillar passenger
29 D pillar driver
30 Engine block (cracked, fractured)
31 Transmission case
32 Dierential case
33 Axle housing
34 Suspension (passenger front)
MOTOR VEHICLE DAMAGE LOCATION REFERENCE CHART
Q1: Was the primary incident due to impact/collision?*
If yes,then complete section Primary Impact damage / severity coding for motor vehicle. Tick the check box and provide appropriate impact damage / severity
code(s) against each numbered ‘damage location’ where the motor vehicle is damaged in the table below: (refer to motor vehicle damage location chart above).
Also answer supplementary question (if applicable).
Tick Incident type Allowable damage / Severity code
(I) - Impact A, B, C, D, E (restraints or whole vehicle only), F, G
Q1.1: If both longitudinals (17 and 21) were subjected to structural damage (C), please indicate if both longitudinal rails are damaged to the extent that both
require Original Equipment Manufacturer (OEM) replacement.
YES
NO
If no, then complete section Primary Non-impact damage / severity coding for motor vehicle. Choose the appropriate primary incident type by ticking the
respective check box against the incident type (tick one only). For the chosen incident also provide appropriate damage / severity code against each numbered
damage location where the motor vehicle is damaged in the table on the next page (refer to motor vehicle damage location reference chart above). Also answer
supplementary questions (whichever is applicable).
RECORD DAMAGE DETAILS OF PRIMARY INCIDENT FOR MOTOR VEHICLE*
Location group: External panels (incl roof) Engine Whole vehicle Interior Roof Pillars
Location code: 1 2 3 4 5 6 8 7 14 9 8 22 23 24 25 26 27 28 29
Panel severity (A/B):
Structural severity (C/D):
Mechanical severity (F/G):
Unrepairable (E):
Location group: Floor plan Fire Wall Longitudinals Suspensions Mechanical Restraints
Locations code: 15 18 19 20 16 17 21 34 35 36 37 30 31 32 33 38 39 40 41
Structural severity (C/D)
Mechanical severity (F/G)
Unrepairable (E):
PRIMARY IMPACT DAMAGE / SEVERITY CODING FOR MOTOR VEHICLE
PRIMARY NON IMPACT DAMAGE / SEVERITY CODING FOR MOTOR VEHICLE
Note: Selection of ‘Dismantled’ is limited to auto-dismantlers and other preauthorised notiers.
Q1.2: If you have recorded major vandalism damage (J) at location roof (8), indicate if the damage has aected the structural member?
Q1.3: If you have recorded burnt/blistered damage (N) at location roof (8), indicate if the damage has aected the structural member?
Q1.4: If the interior (9) and/or whole (14) motor vehicle was subjected to water damage, indicate if the internal cabin was inundated with water exceeding the
level of the inner door sill?
Q3: Do you wish to record a secondary incident for this motor vehicle?*
NOTE: Secondary incident is not permitted if notier is an auto-dismantler OR if the primary incident type recorded is dismantled.
YES
NO
YES
NO
(NOTE: Motor vehicle must be declared a statutory write o where immersion rises above the level of the inner door sill).
YES
NO
YES (Provide additional comments in the box below to support the statutory write o)NO (Skip to Q3)
Q2: Has the motor vehicle been assessed as a statutory write o?*
YES (Proceed to record damage details of secondary incident for motor vehicle section i.e. Q4)
NO (Skip to declaration section)
Location group:
External panels
(incl roof)
Engine
Whole
vehicle
Interior Roof Pillars
Location code: 1 2 3 4 5 6 8 7 14 9 8 22 23 24 25 26 27 28 29
Tick one Incident type
Allowable damage/
severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
F - Fire
E
N,O,P
W - Water (salt or
fresh)
L,M
H - Hail A,B
D - Dismantled H
Location group: Floor plan Fire wall Longitudinals Suspensions Mechanical Restraints
Location code: 15 18 19 20 16 17 21 34 35 36 37 30 31 32 33 38 39 40 41
Incident type
Allowable damage/
severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
F - Fire
E
N,O,P
Tick Incident type Allowable damage / Severity code
(I) - Impact A, B, C, D, E (restraints or whole veh only), F, G
RECORD DAMAGE DETAILS OF SECONDARY INCIDENT FOR MOTOR VEHICLE (IF APPLICABLE)
NOTE: Only certain combinations of incident types are permitted for recording primary and secondary incidents. Refer to allowable primary and secondary incident
type combinations reference table for details.
Q4: Was the secondary incident due to impact/collision?
If yes, then complete section Secondary Impact damage / severity coding for motor vehicle. Tick the check box and provide appropriate impact damage / severity
code(s) against each numbered damage location where the motor vehicle is damaged in the table below (refer to motor vehicle damage location reference chart):
If no, then complete section Secondary Non-impact damage / severity coding for motor vehicle. Choose the appropriate primary incident type by ticking the
respective check box against the incident type (tick one only). For the chosen incident also provide appropriate damage / severity code against each numbered
‘damage location’ where the motor vehicle is damaged in the table below (refer to motor vehicle damage location reference chart).
Note: Selection of ‘Dismantled’ is limited to auto-dismantlers and other preauthorised notiers.
Location group: Floor plan Fire Wall Longitudinals Suspensions Mechanical Restraints
Locations code: 15 18 19 20 16 17 21 34 35 36 37 30 31 32 33 38 39 40 41
Structural severity (C/D)
Mechanical severity (F/G)
Unrepairable (E):
Location group: Floor plan Fire wall Longitudinals Suspensions Mechanical Restraints
Location code: 15 18 19 20 16 17 21 34 35 36 37 30 31 32 33 38 39 40 41
Incident type Allowable damage/severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
F - Fire
E
N,O,P
SECONDARY IMPACT DAMAGE / SEVERITY CODING FOR MOTOR VEHICLE
SECONDARY NON IMPACT DAMAGE / SEVERITY CODING FOR MOTOR VEHICLE
Location group: External panels (incl roof) Engine Whole vehicle Interior Roof Pillars
Location code: 1 2 3 4 5 6 8 7 14 9 8 22 23 24 25 26 27 28 29
Panel severity (A/B):
Structural severity (C/D):
Mechanical severity (F/G):
Unrepairable (E):
Location group:
External panels
(incl roof)
Engine
Whole
vehicle
Interior Roof Pillars
Location code: 1 2 3 4 5 6 8 7 14 9 8 22 23 24 25 26 27 28 29
Tick one Incident type
Allowable damage/
severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
F - Fire
E
N,O,P
W - Water (salt or
fresh)
L,M
H - Hail A,B
D - Dismantled H
RECORD DAMAGE DETAILS FOR MOTORCYCLE
MOTORCYCLE DAMAGE LOCATION REFERENCE CHART
Q1: Was the primary incident due to impact/collision?*
If yes, then complete section Primary Impact damage / severity coding for motorcycle. Tick the check box and provide appropriate impact damage / severity
code(s) against each numbered ‘damage location’ where the motorcycle is damaged in the table below: (refer to motorcycle damage location chart above).
Tick Incident type Allowable damage / Severity code
(I) - Impact A, B, C, D, E (whole vehicle only), F, G
Location group: Front Rear Engine Whole Vehicle
Location code: 10 12 13 7 14
Panel severity (A/B):
Structural severity (C/D):
Mechanical severity (F/G):
Unrepairable (E):
If no, then complete section Primary Non-impact damage / severity coding for motorcycle. Choose the appropriate primary incident type by ticking the respective
check box against the incident type (tick one only). For the chosen incident also provide appropriate damage / severity code against each numbered ‘damage
location’ where the motorcycle is damaged in the table below (refer to motorcycle damage location reference chart above). Also answer supplementary question
(if applicable).
NOTE:
• Selection of ‘Dismantled’ is limited to auto-dismantlers and other preauthorised notiers.
• Where an entire motorcycle has been subjected to salt water damage (L) the motorcycle must be declared a statutory write o.
Location group: Front Rear Whole Vehicle
Location code: 10 12 13 14
Tick one Incident Type Allowable damage/severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
W - Water (salt or
fresh)
L,M
F - Fire
E
N,O,P
H - Hail A,B
D - Dismantled H
PRIMARY NON IMPACT DAMAGE / SEVERITY CODING FOR MOTORCYCLE
RECORD DAMAGE DETAILS OF PRIMARY INCIDENT FOR MOTORCYCLE*
PRIMARY IMPACT DAMAGE / SEVERITY CODING FOR MOTORCYCLE
PRIMARY NON IMPACT DAMAGE / SEVERITY CODING FOR MOTORCYCLE CONT.
Q1.1: If the whole motorcycle (14) was subjected to fresh water damage (M), indicate if the period of immersion exceeded 48 hours.
NOTE: Only certain combinations of incident types are permitted for recording primary and secondary incidents. Refer to allowable primary and secondary incident
types combinations reference table for details.
YES
NO
YES (Provide additional comments in the box below to support the statutory write o)
YES (Proceed to record damage details of secondary incident for motorcycle section below)
If yes, then complete section Secondary Impact damage / severity coding for motorcycle. Tick the check box and provide appropriate impact damage / severity
code(s) against each numbered damage location where the motorcycle is damaged in the table below (refer to motorcycle damage location reference chart on the
previous page):
If no, then complete section Secondary Non impact damage / severity coding for motorcycle. Choose the appropriate secondary incident type by ticking the
respective check box against the incident type (tick one only). For the chosen incident also provide appropriate damage / severity code against each numbered
damage location where the motorcycle is damaged in the table below (refer to motorcycle damage location reference chart on the previous page).
NO (Skip to Q3)
NO (Skip to declaration)
(NOTE: The motorcycle must be declared a statutory write o if immersed for longer than 48 hours.)
Q2: Has the motorcycle been assessed as a statutory write o?*
Q3: Do you wish to record a secondary incident for this motorcycle?*
Q4: Was the secondary incident due to impact/collision?
Tick Incident type Allowable damage / Severity code
(I) - Impact A, B, C, D, E (whole vehicle only), F, G
Location group: Front Rear Engine Whole vehicle
Location code: 10 12 13 7 14
Panel severity (A/B):
Structural severity (C/D):
Mechanical severity (F/G):
Unrepairable (E):
RECORD DAMAGE DETAILS OF SECONDARY INCIDENT FOR MOTORCYCLE (IF APPLICABLE)
Location group: Front Rear Whole Vehicle
Location code: 10 12 13 14
Tick one Incident Type Allowable damage / severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
W - Water (salt or
fresh)
L,M
F - Fire
E
N,O,P
H - Hail A,B
D - Dismantled H
SECONDARY IMPACT DAMAGE / SEVERITY CODING FOR MOTORCYCLE
SECONDARY NON IMPACT DAMAGE / SEVERITY CODING FOR MOTORCYCLE
NOTE: Secondary incident is not permitted if notier is an auto-dismantler OR if the primary incident type recorded is dismantled.
RECORD DAMAGE DETAILS FOR CARAVAN
CARAVAN DAMAGE LOCATION REFERENCE CHART
8
ROOF
9
INTERIOR
14 Whole vehicle 17 Chassis/structural rails (left) 21 Chassis/structural rails (right)
Q1: Was the primary incident due to impact/collision?*
If yes, then complete section Primary Impact damage / severity coding for caravan. Tick the check box and provide appropriate impact damage / severity
code(s) against each numbered ‘damage location’ where the caravan is damaged in the table below: (refer to caravan damage location chart above).
Tick Incident type Allowable damage / Severity code
(I) - Impact A, B, C, D, E (whole vehicle only)
Location group: Front Rear Roof Whole vehicle Interior Longitudinals
Location code: 10 11 8 14 9 17 21
Panel severity (A/B):
Structural severity (C/D):
Unrepairable (E):
If no, then complete section Primary Non-impact damage / severity coding for caravan. Choose the appropriate primary incident type by ticking the respective
check box against the incident type (tick one only). For the chosen incident also provide appropriate damage / severity code against each numbered ‘damage
location’ where the caravan is damaged in the table below (refer to caravan damage location reference chart above).
NOTE: Selection of ‘Dismantled’ is limited to auto-dismantlers and other preauthorised notiers.
Location group: Front Rear Roof Whole Vehicle Interior
Location code: 10 11 8 14 9
Tick one Incident Type Allowable damage / severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
W - Water (salt or
fresh)
L,M
F - Fire
E
N,O,P
H - Hail A,B
D - Dismantled H
PRIMARY IMPACT DAMAGE / SEVERITY CODING FOR CARAVAN
PRIMARY NON IMPACT DAMAGE / SEVERITY CODING FOR CARAVAN
RECORD DAMAGE DETAILS OF PRIMARY INCIDENT FOR CARAVAN*
RECORD DAMAGE DETAILS OF PRIMARY INCIDENT FOR CARAVAN CONT.
NOTE: Only certain combinations of incident types are permitted for recording primary and secondary incidents. Refer to allowable primary and secondary incident
types combinations reference table for details.
NOTE: Second incident is not permitted if notier is an auto-dismantler OR if the primary incident type recorded is dismantled.
YES (Provide additional comments in the box below to support the statutory write o)
YES (Proceed to record damage details of secondary incident for caravan section below)
If yes, then complete section Secondary Impact damage / severity coding for caravan. Tick the check box and provide appropriate impact damage / severity
code(s) against each numbered damage location where the caravan is damaged in the table below (refer to caravan damage location reference chart):
If no, then complete section Secondary Non impact damage / severity coding for caravan. Choose the appropriate secondary incident type by ticking the respective
check box against the incident type (tick one only). For the chosen incident also provide appropriate damage / severity code against each numbered damage
location where the caravan is damaged in the table below (refer to caravan damage location reference chart).
NO (Skip to Q3)
NO (Skip to declaration)
Q2: Has the caravan been assessed as a statutory write o?*
Q3: Do you wish to record a secondary incident for this caravan?*
Q4: Was the secondary incident due to impact/collision?
Tick Incident type Allowable damage / Severity code
(I) - Impact A, B, C, D, E (whole vehicle only)
RECORD DAMAGE DETAILS OF SECONDARY INCIDENT FOR CARAVAN (IF APPLICABLE)
Location group: Front Rear Roof Whole Vehicle Interior
Location code: 10 11 8 14 9
Tick one Incident Type Allowable damage / severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
W - Water (salt or
fresh)
L,M
F - Fire
E
N,O,P
H - Hail A,B
D - Dismantled H
Location group: Front Rear Roof Whole vehicle Interior Longitudinals
Location code: 10 11 8 14 9 17 21
Panel severity (A/B):
Structural severity (C/D):
Unrepairable (E):
SECONDARY IMPACT DAMAGE / SEVERITY CODING FOR CARAVAN
SECONDARY NON IMPACT DAMAGE / SEVERITY CODING FOR CARAVAN
NOTE: Selection of ‘Dismantled’ is limited to auto-dismantlers and other preauthorised notiers.
RECORD DAMAGE DETAILS FOR TRAILER
TRAILER DAMAGE LOCATION REFERENCE CHART
14 Whole vehicle 17 Chassis/structural rails (left) 21 Chassis/structural rails (right)
Q1: Was the primary incident due to impact/collision?*
If yes, then complete section “Primary Impact damage / severity coding for trailer”. Tick the check box and provide appropriate impact damage / severity
code(s) against each numbered ‘damage loction’ where the trailer is damaged in the table below: (refer to trailer damage location chart above).
Tick Incident type Allowable damage / Severity code
(I) - Impact A, B, C, D, E (whole vehicle only)
Location group: Front Rear Whole vehicle Longitudinals
Location code: 10 11 14 17 21
Panel severity (A/B):
Structural severity (C/D):
Unrepairable (E):
If no, then complete section “Primary Non-impact damage / severity coding for trailer”. Choose the appropriate primary incident type by ticking the respective
check box against the incident type (tick one only). For the chosen incident also provide appropriate damage / severity code against each numbered ‘damage
location’ where the trailer is damaged in the table below (refer to trailer damage location reference chart above).
NOTE: Selection of ‘Dismantled’ is limited to auto-dismantlers and other preauthorised notiers
Location group: Front Rear Whole Vehicle
Location code: 10 11 14
Tick one Incident Type Allowable damage / severity
M - Malicious/
Vandalism/Stripping
E
H,I,J,K
W - Water (salt or
fresh)
L,M
F - Fire
E
N,O,P
H - Hail A,B
D - Dismantled H
PRIMARY IMPACT DAMAGE / SEVERITY CODING FOR TRAILER
PRIMARY NON IMPACT DAMAGE / SEVERITY CODING FOR TRAILER
RECORD DAMAGE DETAILS OF PRIMARY INCIDENT FOR TRAILER*
RECORD DAMAGE DETAILS OF PRIMARY INCIDENT FOR TRAILER CONT.
NOTE: Only certain combinations of incident types are permitted for recording primary and secondary incidents. Refer to allowable primary and secondary incident
types combinations reference table for details.
NOTE: Second incident is not permitted if notier is an auto-dismantler OR if the primary incident type recorded is dismantled.
YES (Provide additional comments in the box below to support the statutory write o)
YES (Proceed to record damage details of secondary incident for trailer section below)
If yes, then complete section “Secondary Impact damage / severity coding for trailer. Tick the check box and provide appropriate impact damage / severity code(s)
against each numbered damage location where the trailer is damaged in the table below (refer to trailer damage location reference chart):
If no, then complete section Secondary Non impact damage / severity coding for trailer. Choose the appropriate secondary incident type by ticking the respective
check box against the incident type (tick one only). For the chosen incident also provide appropriate damage / severity code against each numbered damage
location where the trailer is damaged in the table below (refer to trailer damage location reference chart).
NO (Skip to Q3)
NO (Skip to declaration)
Q2: Has the trailer been assessed as a statutory write o?*
Q3: Do you wish to record a secondary incident for this trailer?*
Q4: Was the secondary incident due to impact/collision?
Tick Incident type Allowable damage / Severity code
(I) - Impact A, B, C, D, E (whole vehicle only)
DECLARATION*
RECORD DAMAGE DETAILS OF SECONDARY INCIDENT FOR TRAILER (IF APPLICABLE)
Location group: Front Rear Whole vehicle Longitudinals
Location code: 10 11 14 17 21
Panel severity (A/B):
Structural severity (C/D):
Unrepairable (E):
Location group: Front Rear Whole Vehicle
Location code: 10 11 14
Tick one Incident Type Allowable damage / severity
M - Malicious/Vandalism/Stripping
E
H,I,J,K
W - Water (salt or fresh) L,M
F - Fire
E
N,O,P
H - Hail A,B
D - Dismantled H
NOTE: Selection of ‘Dismantled’ is limited to auto-dismantlers and other preauthorised notiers
SIGNATURE OF DECLARANT*
I declare that the information on this form is true and correct. I understand that under the Road Trac (Administration) Act 2008, it is an oence to provide false
or misleading information.
DATE*
/ /
SECONDARY IMPACT DAMAGE / SEVERITY CODING FOR TRAILER
SECONDARY NON IMPACT DAMAGE / SEVERITY CODING FOR TRAILER
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Written-O Vehicle Notication Form (Services Australia)

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Completed 30 June 2021

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