Motor Claim

What is your relationship with ALIG?

I'm insured by ALIG and wish to report a claim.
I'm claiming against ALIG policy holder, as a third party.

Type of Damage
Motor claim / bodily injury
(Damage injury caused by a vehicle due to an impact with other vehicle or people, animals, etc...)
Motor claim material damage only.

Insured Information
(please fill as information written on your own policy)

Name of policy holder*
Name of driver*
Date of birth*
Policy number*
Valid to*
Plate number*
Expert name (if he was available)

Residence

Address
City
Home number*
Cell number
E-mail*

Please indicate the damages caused by the accident*:

Please indicate of how the accident occurred*:

Third Party Information (if available)

Name
Name of the driver
Date of birth
Insurence company name (if insured)
Policy number (if insured)
Plate number
Expert name (if he was available)

Third Party Residence

Address
City
Home number
Cell number
E-mail

Please indicate the damages caused by the accident:

Please indicate of how the accident occurred: