Tema
Debat

Claim report - motor vehicle

If you have been hit by an unknown motor vehicle or by a motor vehicle without liability insurance, you must fill in the damage report below and press "Send".

 

The claim report is automatically sent to DFIM. We will contact you and explain the further course of the case once we have received your claim report.

 

 

 

{{select_notification_type}}

{{choose_notification_types_below}}

{{headline_insured}}

{{name}}
{{address}}
{{postal}}
{{position}}
{{phone}}
{{email}}
{{are_you_vat_registered}}
{{who_is_claiming}}
{{name}}
{{address}}
{{postal}}
{{phone}}
{{email}}
{{name}}
{{address}}
{{postal}}
{{phone}}
{{email}}

{{information_about_the_accident}}

{{address}}
{{postal}}
{{information_accident_place_description}}
{{when_did_the_accident_happen}}
{{country}}
{{describe_the_accident}}

{{damage_to_vehicle}}

{{has_your_vehicle_been_damaged}}
{{describe_damage}}
{{regno}}
{{model_brand}}
{{year}}
{{vehicle_in_company}}
{{is_the_vehicle_comprehensively_insured}}
{{insurance_company}}

{{driver_of_the_vehicle}}

{{driver_same_as_the_injured_party}}
{{cpr}}
{{name}}
{{address}}
{{postal}}
{{position}}

{{personal_injury}}

{{was_there_any_personal_injury}}

{{Person}} 1

{{button_add_person}}
{{cpr}}
{{name}}
{{address}}
{{postal}}
{{do_you_have_accident_insurance}}
{{accident_insurance_company}}
{{been_to_emergency_room}}
{{work_related_injury}}
{{member_denmark}}
{{sick_leave_accident}}
{{sick_leave_from_date}}
{{to_date}}
{{still_on_sick_leave}}
{{information_about_work_situation}}
{{professional job}}
{{job_title}}
{{information_work_before_accident}}
{{number_of_hours_per_week}}
{{full_pay_during_illness}}
{{received_sickness_benefit}}
{{describe_current_problems}}
{{received_or_are_you_still_receiving_treatment}}
{{describe_the_treatments}}
{{name_address_general_practitioner}}
{{other_info_treatment}}
{{describe_person_damage}}

{{damage_to_things_including_bicycles}}

{{damage_related_to_the_accident}}
{{damage_to_the_means_of_transport}}
{{other_property_damage}}
{{family_home_insurance}}
{{bicycle_involved_in_the_accident}}
{{you_own_the_bike}}
{{if_yes_which_company}}

{{the_other_party}}

{{is_there_a_known_other_party}}
{{name}}
{{address}}
{{postal}}
{{country}}
{{car_brand_type}}
{{regno}}.
{{insurance_company}}
{{green_card_no}}
{{additional_info_other_party}}
{{who_has_the_information}}
{{is_other_party_hidnrun}}
{{other_information}}
{{is_other_party_hidnrun}}

{{police_report}}

{{accident_reported_police}}
{{police_jurisdiction}}
{{police_station}}
{{police_journal_number}}

{{witnesses}}

{{witnesses_to_the_accident}}

{{witness}} 1 {{add_witness}}

{{name}}
{{address}}
{{postal}}
{{phone}}
{{email}}
{{location_witness}}

{{more_information}}

{{banking_details}}

{{send_money_bank}}
{{send_money_nemkonto}}
{{regno}}
{{accountno}}

{{documentation}}

{{attach_relevant_documentation}}
{{morefiles}}
  • Philip Heymans Allé 29, 2900 Hellerup
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