Car insurance claim form | Claim Pro Insurance Broker

Insurer name *

Insurance contract no. *

Full name of the policyholder *

Email *

Please fill it out accurately so we can follow up with you about your claim and request additional documentation.

Date and time of the insurance incident *

Datum

Zeit

Traffic police case reference no.

Attach an acknowledgement of receipt from police

Klicke oder ziehe eine Datei in diesen Bereich zum Hochladen.

The other vehicle's plate no. *

The collision was not with a car (e.g., if the collision was with a bicycle), please write ‘bicycle’ in the field.

Full name and contact details of the other party *

Inform the other party that we have been delegated to handle the claim and communicate on their behalf.

Witness contact information

Full name, phone number, and email or address

Attach | Photos of damaged parts of the vehicle *

Klicke oder ziehe Dateien in diesen Bereich zum Hochladen. Du kannst bis zu 10 Dateien hochladen.

Estimated repair cost

Klicke oder ziehe eine Datei in diesen Bereich zum Hochladen.

In cases of overcharges, the insurer may proceed with the damage assessment further, so please do not proceed with the repair before agreeing to the estimate from the insurance company.

Statement of incident *

For the protection of the policyholder, please provide a detailed description of the incident. We will handle the claim process on your behalf to avoid any statements that could be used against you.

Data use agreement and permission *

I consent to having Sicher Sicher GmbH store and use my submitted information and documents so they can proceed with my claim process.

Name