Damage report

Please attach scanned version of the European Accident Report or send it by fax to 01/60102 extension 9352 or 9353!

Accident (Required)

involving third party
not involving third party

Driver details

License plate number (Required)

Company (Required)

Driver (Required)

Driving license number / issuing authority / date issued (Required)

Car make / model / type

Insurance company

Telephone number (Required)

Fax number

eMail address (Required)

Damage information

Date / time damage occurred (Required)

/ /

Location (Street and number, city, post code) (Required)

Accident involving third party

Name of the third party (Required)

License plate number of the third party (Required)

Insurance company of the third party (Required)

Address of the third party (Required)

Telephone number of the third party

Witness to the accident

Address of the witness

Telephone number of the witness

Details of accident (Required)

Accident without third party

Type of damage (Required)

Own fault
Parking damage (official report required)
Vandalism (official report required)
Burglary (official report required)
Collision with animals (official report required)
Damage caused by animals
Natural hazard (like hail, storm, flood, landslide)
Tyre damage
Breakage of glass

Location of the damage (Required)

Please mark the point of initial impact

Damaged parts (Required)

Attachment

Enclosure

Attachment (photo, European accident report e.g.)

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