Euroleaseuto

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:

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:

Type:*	car lorry bus car equipment Other
Brand:*
Model*
Car registration Number*
Rama:*
Color:*

Road accident notification