KASKO claim application

Car registration number
Car brand
Model name


Date of incident:
Time:


Incident location:
Google Maps link (optional):


Incident report:
Detailed description of the incident and vehicle damage:


Driver’s information

Full name
Personal ID


Contact information

Email
Phone number

Preferred service center
Comments


Photos from the scene:




Mutual statement:

Other documents:

 I agree that my personal data will be processed