Notification of an insured event
Motor CASCO
 Items marked with * are required. To the report of an insured event, you can enclose 3 files - a driving license, vehicle registration papers, etc Please, fill in as many information as possible.
 
Information about the incident

*Motor Casco:

 Nr of instance contract:
*Date of the accident D/M/Y:

*Time of the accident:


*Place of the accident:

 Country:
*Your email:
 *Email of the Fleet Manager of your company:

The injured - insurance (TP holder)
Name of the owner:
Address (street, city, ZIP code):
 VAT:
*Registration number:
 *Type of car:
 Year:
*Name of the driver:
 *Address (street, city, ZIP code):
 *Phone Nr.:
Nr. of Driving License :
 Group of driving license:
 Release Date Driving license:
*The fault accident
your party:
Additional information

*Description of the accident:
*The extent of damage to own vehicle:

*Injured person:

Injured person (description):

*Place of repair:

*Country: *ZIP Code :

   
*The police was called:
    
Date D/M/Y:
The number of police protocol:
In case the police was not called, enclose a copy of your driving license and send as an enclosure or send it to nehody@allgroup.cz
Upload a file to the server
Enclosure 1 (max. 1MB) :
Enclosure 2 (max. 1MB) :
Enclosure 3 (max. 1MB) :
In :
Date D/M/Y:06/02/2012

 
* Check for departure: