Vent venligst …

Report damage

Complete and submit the form to make a claim.

Company/customer no.

Enter company name or customer no.

Name of reporter

Enter your name.

Claimant’s mobile no.

Enter your mobile no.

E-mail address

Enter your e-mail address here

What has been damaged?

State car, building, personal property or other.

Where did the incident take place?

Enter the address here.

When did the incident take place?

State date.

How did the incident occur?

Describe briefly what happened.

What have you done in the meantime?

What have you done to limit the damage?

Witnesses/other party

Enter name and contact details for witnesses or other party, registration number if applicable

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