Declare an accident

Send your claim using our online form
  • Compulsory fields
  • One of these two fields is compulsory
Information of the accident
Reasons for Opening a dossier
Information of the claimant
Information of the injured party
If it is unknown, please let us know.
Only enter one plate number. If it is unknown, please let us know.
Material damages?
Personal damages?
Information of the responsible party
Only enter one plate number.
If it is unknown, please let us know.
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