Report damage

First Name*

Last Name*

Personal Identification Code

Phone Number*

Email*

Address

My Relationship to the Incident
Cause of DamageInjured party

Date (dd.mm.yyyy)*

Time (HH:mm)*

My Car's Registration Number*

Location of the Accident*

Please provide the most accurate address or location - (county, city/rural municipality, street/village, house number/intersection, highway kilometer, etc.).

Description of the Accident Circumstances*

Please make sure to include the make, model, and registration numbers of all vehicles involved in the accident, along with the details of individuals and witnesses: name, personal identification code, phone number, email address; indicate if there were cameras or similar devices at the scene. If personal identification codes and contact details of participants are provided in the "Traffic Accident Report" attached to this notification, there's no need to list them separately.

Visible Injuries and Damages Resulting from the Accident:

Did Anyone Get Injured in the Accident?*

Was the Police Notified of the Accident?*

Was the Traffic Accident Report Form Filled Out?

Attachments

(photos: vehicles, injuries, accident scene; diagrams, on-site completed traffic accident report, copy of the vehicle's technical passport, copy of the driver's license, repair cost estimation)

Attachment 1 (size up to 4MB)

Attachment 2 (size up to 4MB)

Attachment 3 (size up to 4MB)

Attachment 4 (size up to 4MB)

Estimated Amount of Damage (EUR):

I confirm the accuracy of the provided information and give consent to AS Inges Kindlustus to process this data!