Vehicle claim notice

Notifier details

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Insured event

Event date

Time

Country

Venue

Don't know the exact location of the event

Find address

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Venue additional information

Type of damage

Damage was caused by

Loss event description

Was Police/Rescue Board notified?

Yes

Notification date

Traffic accident submission filled

Yes

Details of witnesses

Participants

My connection

Recipient of the damage

Private person

Legal person

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Name

Registry code issuer

Registration code

E-mail

Phone number

Description of the damaged item

Damaged item description

Description of the incurred damages

Details of my vehicle

The vehicle is registered

Yes

Registration number

Manufacturer's mark / serial number

Make

Model

Damages to the vehicle

Driver

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

The driver was under the influence of alcohol or drugs

Yes

Other vehicle details

The vehicle is unknown

Yes

No other vehicles were involved in the accident

The vehicle is registered

Yes

Registration number

Manufacturer's mark / serial number

Make

Model

Vehicle damages

Driver

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone

The driver caused the accident

Yes

The driver was under the influence of alcohol or drugs

Yes

Other vehicle details

The vehicle is unknown

Yes

No other vehicles were involved in the accident

The vehicle is registered

Yes

Registration number

Manufacturer's mark / serial number

Make

Model

Vehicle damages

Driver

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone

The driver caused the accident

Yes

The driver was under the influence of alcohol or drugs

Yes

Were there any other participants?

Yes

Other participants

Person

Persons involved

Personal information is known

Yes

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Person type

Private person

Legal person

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Company name

Registry code issuer

Registry code

E-mail

Phone number

Description of damage

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Vehicle

The vehicle is unknown

Yes

The vehicle is registered

Yes

Registration number

Manufacturer's mark / serial number

Make

Model

Vehicle damages

Driver information

Driver

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

The driver caused the accident

Yes

The driver was under the influence of alcohol or drugs

Yes

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Indemnity

I request an indemnity for the incurred damages

Yes

Damage cost estimation

Beneficiary

Bank account number

Additional information and confirmations

Additional information

I confirm the accuracy of the above data and agree to the processing of my personal data by LHV Kindlustus in accordance with the principles of LHV customer data processing.

I know that if I knowingly submit wrong data, then insurer has the right to decrease compensation or refuse to pay compensation completely.

I agree that insurer has the right to request additional information concerning the claim from persons that possess it.