For Car Workshops

Online Claims Form for Car Workshops

A grossly negligent or intentionally incorrect answer or failure to answer the following questions can lead to (complete or partial) exemption from payment.

Repair shop data

Name of the repair shop *

Contact person *

Telephone *

Email *

Customer data

First name *

Surname *

Street, No.

ZIP, city

Vehicle data

Current mileage *

Initial registration

Chassis number (min. last 7 digits) *

Brand / manufacturer *

Tuning

yes

Goodwill checked?

yes

Damage data

Contract number *

Claim number (if available)

Damage occurrence date *

Cost estimate *

Repair shop order

Customer complaint *

Result

Additional documents

Maintenance record

Vehicle registration certificate Part I

Others

Evidence of damage

Images/videos related to the vehicle

Yes, I have read the privacy policy and agree that the data I have provided may be collected and stored electronically. My data will only be used strictly for the purpose of processing and answering my enquiry. *

I have received and taken note of the information on the consequences of a breach of an obligation to provide information or clarification existing after the occurrence of the insured event. *

All fields marked with an asterisk (*) are mandatory.

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