Notification of an accident / damage event Tenant

Customer data:

Customer number*

Customer name*

Registration number of the damaged rental vehicle*

Mail*

Phone*

Address (street)*

Address (zip code)*

Address (city)*

Country*

Accident opponent data:

Name, first name / company*

Opposite side indicator*

Insurance company*

Insurance number*

Existing witnesses:

1st witness surname, first name*

1st witness address*

More witnesses
– Bitte auswählen –12

About the accident:

Date*

Time*

Location*

Course of damage*

Fault*
– Bitte auswählen –Own faultThird-party fault
Vehicle ready to drive*
– Bitte auswählen –YESNO

I have read the privacy policy. (We process all data marked as voluntary on the basis of your consent).*Privacy policy

Here you can send us police report/documents/pictures/videos about the accident (max. 10 files a 10MB = 100MB limit - allowed files: doc|docx|pdf|jpg|jpeg|png|mp4|mov|avi):*

After receiving this form, we will contact you as soon as possible.