Claim form

You get the car claim form when you purchase car insurance.

Go directly to

All about the claim form
Frequently asked questions about the claim form

All about the claim form

The car claim form is given to you when you purchase car insurance. You should always keep this claim form in your car from then on. It is even better to have two in case you get involved in a chain collision or accidentally get involved in 2 car claims in 1 day.

The claim form can also be used when you have damage with a moped or motorcycle.

Also read our tips on how to fill out a claim form or what the dramatic consequences can be if you fill out a claim form incorrectly.

How do I get a claim form?

When you purchase car insurance, you will receive a claim form along with the policy. Then keep it in the car so you always have it handy if you sustain damage. Do you no longer have the claim form? Then you can request it from your intermediary or insurance company. You can also download and print the claim form here.

When to fill out claim form?

You fill out the claim form the moment you are involved in an accident, such as when you drive off another car's mirror or when another driver collides with you. It is best to fill out the claim form immediately after the accident because that is when you can best remember exactly what happened. It is wise to fill out the front of the claim form together with the other party. Both parties need a completed form to send to their insurer. The back side you can fill out yourself at home if necessary. This mainly contains your personal information.

How to fill out claim form?

Filling out the claim form correctly is very important. A mistake while filling it out can slow down process, resulting in a slower claim settlement. Therefore, it is important that you fill out the form immediately after the accident. Therefore, always have a claim form in your glove box. That way you can be sure that you fill out the form completely and correctly. To get you started, we have made a video explaining step by step how to fill out a claim form

Download FREE claim form through Alpina

Download a European claim form here.

Frequently asked questions about the claim form

Can filling out a proper claim form speed up the process?

If you no longer have a claim form, request a new form from your insurer or your agent. You can also download a claim form from our site. If you have any questions about the form or any other subject, please feel free to contact us. We will be happy to help you.

How do I fill out a claim form?

Are you involved in a collision? Then you and the other party complete the claim form. You do this on the spot, immediately after the accident. That way, everything is still fresh in your mind and you can fill out the form correctly. The form has a front and a back. You only need to fill out the front together with the other party. You can also fill out the back side at home. Then send the claim form to your insurer. Below we will briefly explain both sides of the form.

What should I do at the front of a claim form?

On the front of the claim form you will see numbers 1 through 15. For each number there is information that you and the other party must fill out. Go through all the steps together calmly and fill everything in as completely as possible.

Also clearly discuss with the opposing party who enters their information under vehicle A, and who enters their information under vehicle B. Number 6 asks for the policyholder's information. Number 9 asks for the driver's information. At number 9, you always enter the details of the driver at the time of the collision. Was your vehicle parked at the time of the collision and no one was present? Then you can fill in nothing at driver.

In the middle of the form, you will see number 12, marked as "pertinent." Here you can check the box(es) that apply. This makes it a lot clearer for the insurance company to assess how the collision occurred. At the bottom of the form, at number 14, indicated as "my comments," both parties can add their own brief explanations.

Once all the information is filled out completely and both parties agree with what is written on the form, the form should be signed by both people. Once signed, the original can be torn loose from the print-through so that both parties involved have their own form.

claim form

What to do on the back of a claim form?

Completing the back of the claim form is often forgotten by insureds. Yet it is very important for the insurance company that the back side is filled out. Filling out the back side can be done quietly at home. You do not need the other party for this. By filling out the back of the form, it makes the claim form become your form.

A lot of information is requested on the back of the claim form, but not everything is equally important. The most important eight items that must be filled out are the following:

Policyholder
Director
Damage to your motor vehicle
Police
Victims
Circumstances during incident
Liability
Date and signature

Please remember to fill in all information covered by these items? Example: The information that falls under policyholder are name, account number, occupation, salaried/self-employed and right to deduct VAT.

If you have also completed the back of the form, you can send it to your insurance company or insurance intermediary. They can then handle your claim.

claim form

More terms claim form

Car damage form

When you purchase car insurance, you will receive a European claim form from the insurer. It is wise to keep it in the glove box of your car so that you always have it to hand. This is because you must fill out this form together with the other party after damage from an accident. Based on this completed form, the insurer can determine who the guilty party is and the amount of damages to be paid. This claim form looks the same throughout Europe, only the language of course differs from country to country. You can therefore use the form throughout Europe.

Buy claim form

You will receive the claim form when you purchase your car insurance. Have you lost the claim form or perhaps you have already used it once? Then you do not need to buy a new claim form. You can simply download this for free on our website. It is wise to do this right away and store the claim form in your car. This way you will always have it at hand. Nowadays, you can also use the mobile app in case of damage. That way you don't have to fill out a form, just answer the questions in the app. You can also add photos of the damage.

Online claim form

Lost your claim form? You can also download it online. Unfortunately, you cannot fill it out online though. However, you can report the damage online via the mobile app. The claim form consists of 14 questions. These are questions about the accident and damage, as well as details about the vehicles involved and their drivers. If you use the app, you can upload photos so the insurer can see the damage with their own eyes. Great, because that way the other party does not later claim that the damage reported is incorrect. Your insurer is automatically notified when you report car damage via the mobile app.

Related pages about the claim form

Calculate car insurance premium directly

License plate

Unknown

Postal code

To calculate premiums, we need the zip code of the primary driver. For private use, the youngest driver must reside at the same address as the applicant. For business use, you can enter the company's zip code here.

House number Addition