Insured Event Report

Vehicle

Make:

Please do not fill in.

Model:

Please do not fill in.

Engine type:

Please do not fill in.

Odometer reading:

Insured event

Date of accident: *

Time of accident: *

Place of accident: *

Type of insured event: *

• Road traffic accident
  A road traffic accident shall mean any collision involving your vehicle (with another vehicle, a person, an animal, a stone or another object).
• Windscreen damage
  Damage is only caused to the vehicle’s windows. No other damage to the vehicle is caused.
• Theft
  Theft shall mean appropriation of an insured vehicle or a part thereof by stealing or robbery.
• Burglary
  Burglary shall mean breaking and entering a vehicle by releasing the locking mechanisms in an unauthorised manner or overcoming other security features by use of force.
• Vandalism
  Vandalism shall mean damage or destruction of a vehicle or a part thereof caused by the deliberate actions of a stranger. A police report is required.
• Natural hazards
  A natural hazard shall mean a fire, explosion, direct lightning strike, falling rocks, landslides or avalanches, falling trees or poles, hailstorms, floods or other water damage and strong wind.

Description of the insured event: *

Description of vehicle damage: *

Small windscreen damage: *

Yes No

Physical injury: *

Yes No

Cause of insured event: *

• Own fault
  The driver of the vehicle (a Volkswagen Financial Services client) is responsible for the damage.
• Caused by another person
  A different known vehicle or other known culprit is responsible for the damage.
• Caused by an unknown person
  An unidentified vehicle or unknown culprit is responsible for the damage.
• Other cause
  The vehicle has been damaged by a natural hazard such as strong wind, a falling tree, etc.

The vehicle was being driven when the insured event occurred: *

Yes No

Driver name: *

Driver surname: *

Birthdate: *

Phone: *

E-mail: *

Annex - Front side of driving licence: *

Max. file size 2 MB.