Report a traffic accident

Basic information about the accident

Choose one of the options *

Police was called * (select one option)

In the accident ... was/were involved * (select one option)

Information about the insured person


Motor vehicle of the insured person

Vehicle type *

Fuel *

Mutual clash points of the vehicle * (mark the damaged part)

FOREPART LEFT
SIDE
RIGHT
SIDE
REAR

Information about the opposite party

Contact information of opposite party

Vehicle type

Mutual clash points of the vehicle

FOREPART LEFT
SIDE
RIGHT
SIDE
REAR

Add photos

Please add only jpg, tif or png files. Maximum size of each file is 500kb.

Summary

Basic information about the accident

I am a damaged

Police was called

Yes

In the accident ... was/were involved

Only my own car

Detailed description of th accident

Date and time of the accident

Place of the accident


Information about the insured person

Name and surname

Date of birth

Driver's license no.

Tel. no.

E-mail


Motor vehicle of the insured person

Vehicle type

Car

Brand

Not specified

Model

Domestic production

Registration mark

Registration document

Contract No.

VIN

Power (kw/hp)

Engine cubic capacity (cm3)

Fuel

Petrol

Year of manufacture

Mutual clash points of the vehicle

Visible damage of the vehicle


Contact information of opposite party

Name and surname

Tel. no.

E-mail

Vehicle type

Car

Mutual clash points of the vehicle

Visible damage of the vehicle


Photos

Overall view

My vehicle

Thank you

Thank you

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