Notification of claim (Minor damage)

Interfaces

Policyholder

Salutation

Company name

Name *

First name *

Street

Zip * / Location *

Mobile phone *

Email *

The mobile number and email address will be used for further communication with you.

Type of contact

Vehicle

Brand *

Type *

License plate *

Kilometer total

Damage

Insurance

Damage date *

Damage location *

Remarks

* = mandatory field