Motor Third Party
Liability Insurance

Event report by liable party

Information about accident

How did the accident happen (detailed in chronological order)? *

INFORMATION ABOUT INSURED VEHICLE

Driver at the time of the accident

INFORMATION ABOUT THIRD PARTY


Information about the other victim of the traffic accident

Fill out other vehicle number

Attach available documents

The size of a single attached document should not exceed 5MB, and the maximum size of all documents should not exceed 30MB. Allowed file types: pdf, jpg, doc, xls, zip, 7z, bmp, png.


DETAILS OF THE NOTIFIER