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Personal data
General info about the damage
Details about the damage
Driver of the vehicle on the moment of the accident
Was there a counterpart involved in the accident?
Verbalising government
Was a report drawn up?
Has there been a breathing test or a blood test?
Where there any witnesses of the accident?
Are there any injured in the accident?
Address of the insured risk
Damage type
Please provide a statement of the losses or damage caused to the building, the contents and to third parties; a repair estimate of the necessary costs; the contact details of the repair company; a global estimate of the damage; an indication of any injured people, … Through the field ‘Attachments and Documents’ you can forward all supporting documents (photographs, purchase invoices, minutes from the police report). Attention: In case you are a tenant, please note that all losses should be notified by the owner to his insurance company!
Remarks / extra information
Annexes and documents
You can upload up to 5 files of type "jpeg", "jpg", "png", "PDF", "doc" or "docx". The total size of all files should not exceed 6 Mb together.

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