Damage report third party liability

Insured Person

    Co-insured person (Information only required in SafetyTool Plus and insofar as this person has caused the damage)

    Information about your insurance

    Does liability insurance with another insurance company exist (e.g. personal liability, boat iability, skipper’s liability insurance etc.)?

    Please inform us about the insurance company, the policy number and the type of insurance

    Information on the claimant

    Are you related to the claimant?

    Do you live in a common household with the claimant?

    Do you have an employment contract with the claimant?

    Is the claimant a crew member?

    Who shall receive the claims payment?

    Unless your bank is located in the European Union, please also provide address and SWIFT code of the bank.

    Description of the damage:

    Is it your fault?

    Is there fault on the part of a third party?

    Did the injured party contribute to the damage?


    Police notification

    In case of accidents while sailing or driving a motorboat, please also answer to the following questions:

    Was the boat you lead

    In case of property damage:

    Was there any noticeable previous damage to the damaged material?

    Is repair possible?

    In case of bodily injury:

    Claims of the injured party

    Have you already settled the damage to the injured party?

    Additional documents / attachments

    By sending this form I confirm the correctness of my data.

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    Versicherungsmakler GmbH
    Abt-Hyller-Straße 4
    88250 Weingarten