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Déclaration de sinistre

Veuillez compléter les sections suivantes

Le·La preneur·se d'assurance

Insured person

Surname
Insurance company
First name
Policy number
Type of vehicle
Registration plates N°.
Vehicle’s mileage
Date, time and place of accident
Damage to own vehicle
To a third party
Injuries
Was the driver of the insured vehicle to blame
Party

Conducteur du véhicule :
Driver of the vehicle :

Surname
First name
Adress and telephone number

Demander un devis pour la réparation et le joindre avec une copie des permis de circulation et de conduire.

Obtain a quotation for the repairs and enclose it with copies of the registration car license and driver driving license

Jointly agreed statement for the vehicle with sketch

Si non compléter le croquis page 2

If not, please make sketch page 2

Names and addresses of witnesses
Bank and address, IBAN (SWIFT) andr account number for remboursements
Name, address and tel. number of the injured party
Type of vehicle
Registration plates N°
Remarks

Notre bureau à Lausanne

Place de la Gare 4
Case postale 265
1001 Lausanne
+41 (0)76 507 68 51

Nos partenaires
Partenaires en assurance de l'entreprise LM Management et du Cabinet Conseils CV Sàrl
Rejoignez-nous sur les réseaux sociaux !

Protection des données

Lm Management illustrés par un logo