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Damage Report

Please fill out the form to report your accident. All fields marked with * are mandatory.

Your Personal Information

Accident Details

Documents

First Name

Please enter your first name

Last Name

Please enter your last name

Street and House Number

Please enter your street with house number

ZIP Code

Please enter a valid ZIP code

City

Please enter your city

Phone Number / Mobile

Please enter your phone or mobile number

Please enter your website

Please enter JS ID

Email Address

Please enter a valid email address

Please enter your mailbox

Your License Plate

Please enter your license plate

License Plate of the Other Party

Please enter the other party’s license plate

Accident Location

Please enter the accident location

Date of Accident

Please enter the accident date

Additional Comments

Please describe the accident in your own words

📷 Damage Photos Select Files

Allowed file types: jpg, png, gif, pdf, webp

📄 Front and Back of Vehicle Registration Select Files

Please upload both sides of the registration

I will submit the images later via Email or WhatsApp

I have read and accept the Privacy Policy

Please accept the privacy policy