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Road accident notification
Eurolease Auto
Central office
Sofia 1797, 16 G.M. Dimitrov Blvd.
T:+359 (02) 96 51 555, F:+359 (02) 96 51 687
info.sofia@euroleaseauto.bg
Road accident notification
Form for
Physical p-n (PP)
Juridicial p-n (JP)
Your application will be reviewed after you complete this form
Financial Leasing Contract No
*
Lessee information
Name of lesse
*
ID No. (JP)
*
Personal No. (PP)
*
Correspondence address:
City
*
Address:
*
Other contact person
Contact person
Name and surname:
*
Personal No
*
Contact person mobile phone:
*
Other mobile phone:
Fixed phone:
*
Other fixed phone:
E-mail:
*
Fax:
Vehicle information
Type:
*
car
lorry
bus
car
equipment
Other
Brand:
*
Model
*
Car registration Number
*
Rama:
*
Color:
*
Event description:
*
Road traffic accident:
Parking damage:
Theft:
Malevolent actions of third persons:
Natural disaster:
Other *:
* Please, describe:
Damage facts:
Location of occurrence:
*
Not declared:
Declared:
Incoming No/Date:
*
Way of damage elimination / compensation payment after damage declaration:
*
Repair in a service station of authorized representative:
letter of assignment
Repair in a trusted service station:
letter of assignment
According to expert valuation:
Other *:
*Please, describe:
Notes:
Date:
Lessee signature: (Seal for JP)
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