What about putting something on the Jeep facebook site?
https://www.facebook.com/jeepaustralia/. Cause that form is not safe as it's not encrypted. Plus it looks like it's going to Allianz going off the small print as below:
Your enquiry will be forwarded to FCA Australia’s Takata Compulsory Recall management service provider, Allianz Worldwide Assistance. FCA and Allianz respect your privacy and we will only use the information you provide for the purposes of processing and fulfilling your request or enquiry. FCA’s Privacy Policy and Allianz’s Privacy Policy contain further details regarding how you can access or correct information we hold about you, how you can make a privacy related complaint, how that complaint will be dealt with and the extent to which your information may be disclosed to overseas recipients.