Accident / claim report
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Accident report

Select one of these three options:

Friendly declaration of accident

ALL FIELDS MARKED WITH * ARE REQUIRED
4. PROPERTY DAMAGE

VEHICLE A (OWN)

6. INSURED (See Insurance Policy)
7. VEHICLE
8. INSURANCE
9. DRIVER (see driver's license)
12. CIRCUMSTANCES. INDICATE "YES" IN EACH BOX AS APPROPRIATE

VEHICLE B (OPPOSITE)

6. INSURED (See Insurance Policy)
7. VEHICLE
8. INSURANCE
9. DRIVER (see driver's license)
12. CIRCUMSTANCES. INDICATE "YES" IN EACH BOX AS APPROPRIATE

SEND

SINCE 1989 AT YOUR SIDE
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Previseguro, S.A. Correduría de Seguros – DGSFP Code J-856.
Has subscribed a Professional Liability policy and financial capacity according to current legislation.
Registered in the R.M. of Madrid, Volume 9493, G. 8233, S. 3ª, Book of Companies, F. 155, H. 73739, Insc. 1ST – CIF A79087607

©2024 Previseguro
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