Notification of an insured event
Third party liability - culprit
 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
*Third party liability
 *Date of the accident D/M/Y:
 *Time of the accident:
*Place of the accident:
 Country:

 *Your email:

*Fleet Manager of your company:
Culprit of the accident
Name of the owner:

*Name of the driver:
 Address (street, city, ZIP code):
Phone of the Driver:
Driving License Nr.:
 Group of driving license:
    

Third party lability – Insurer:
selection
or
The number of insurance contract:
*Registration number:
 Type of car:
The injured party (the holder / user of the vehicle)
In the case of more victims, write their data to email: nehody@allgroup.cz ,also with the number of insured event generated after completing the reports.
*Name and surname of the holder:
 *Address (street, city, ZIP code):

 VAT:
*Name of the driver:
 *Address (street, city, ZIP code):
 Phone Nr.:
Driving License Nr :
 Group of driving license:
    
*Registration number:
 *Type of car :
  Detection of alcohol:
Additional information

*Injured person:

Injured person (description):

*Damage to property (No / Yes - description):

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

Country : ZIP code :
   
*The police was called:
 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: