Claim application
Report a claim | MTPL insurance | If Insurance
Who is reporting?
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Only latin characters allowed
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Only latin characters allowed
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Check the phone number
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Check the e-mail address
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Claim applicant
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Required
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Check the phone number
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Check the e-mail address
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Mediator representative
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Check the phone number
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Check the e-mail address
Claim applicant
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Only latin characters allowed
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Only latin characters allowed
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Check the phone number
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Check the e-mail address
Name {{ model.submitter.name }}
Surname {{ model.submitter.surname }}
ID code {{ model.submitter.code }}
Phone number {{ model.submitter.phoneNumber }}
Email {{ model.submitter.email }}
Name {{ model.submitter.name }}
Company reg. code {{ model.submitter.code }}
Claim applicant
Name {{ model.submitter.contact.name }}
Surname {{ model.submitter.contact.surname }}
ID code {{ model.submitter.contact.code }}
Phone number {{ model.submitter.contact.phoneNumber }}
Email {{ model.submitter.contact.email }}
Name {{ model.repairshop.name }}
Company reg. code {{ model.repairshop.code }}
Mediator representative
Name {{ model.repairshop.representative }}
Phone number {{ model.repairshop.phoneNumber }}
Email {{ model.repairshop.email }}
Claim applicant
Name {{ model.submitter.name }}
Surname {{ model.submitter.surname }}
ID code {{ model.submitter.code }}
Phone number {{ model.submitter.phoneNumber }}
Email {{ model.submitter.email }}
Persons and vehicles involved in this accident
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Vehicle information
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Check the phone number
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Check the e-mail address
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Your vehicle information Applicant vehicle information Vehicle information
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Required
Required
Required
Required
Other vehicles
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Vehicle {{ $index + 2 }}
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Required
Vehicle information
Check the phone number
Check the phone number
Did you drive a car? Yes Did claim applicant drive a car? Yes
Vehicle information
Name {{ model.mainVehicle.driver.name }}
Surname {{ model.mainVehicle.driver.surname }}
ID code {{ model.mainVehicle.driver.code }}
Phone number {{ model.mainVehicle.driver.phoneNumber }}
Email {{ model.mainVehicle.driver.email }}
Did driver of that vehicle cause the accident? Yes No
Was driver drunk? Yes No
Did you cause the accident? Yes No Did claim applicant cause the accident? Yes No
Were you drunk? Yes No Was claim applicant drunk? Yes No
Your vehicle information Applicant vehicle information {{ model.mainVehicle.brandName }} {{ model.mainVehicle.modelName }} ({{ model.mainVehicle.registrationNumber }})
Vehicle information
Vehicle number {{ model.mainVehicle.registrationNumber }}
Brand {{ model.mainVehicle.brandName }}
Model {{ model.mainVehicle.modelName }}
Did more vehicles participate in the accident?
Vehicle
Vehicle number {{ vehicle.registrationNumber }}
Brand {{ vehicle.brandName }}
Model {{ vehicle.modelName }}
Vehicle information
Name {{ vehicle.driver.name }}
Surname {{ vehicle.driver.surname }}
ID code {{ vehicle.driver.code }}
Phone number {{ vehicle.driver.phoneNumber }}
Email {{ vehicle.driver.email }}
Vehicle number {{ model.mainVehicle.registrationNumber }}
Brand {{ model.mainVehicle.brandName }}
Model {{ model.mainVehicle.modelName }}
Accident description
Required
Date not valid
Date can not be in the future
Check the date
Correct time format is: 12:15
Time can not be in the future
Required
Location of the accident
Date and time of the accident {{model.accidentDate | hkDate }} {{model.accidentTime | hkTime }}
Description of the accident
{{ model.accidentDescription }}
Location of the accident
Country {{ model.accidentLocation.country }}
{{ model.accidentLocation.address.formattedAddress }}
Location description
{{ model.accidentLocation.description }}
Additional information
Required
Required
Value must be number