The Motor Insurance Claim Form is a crucial document used in the Belgian insurance market when policyholders need to report a vehicle-related incident and make an insurance claim. It is designed to comply with the Law of 4 April 2014 on Insurance and relevant EU directives, particularly the Motor Insurance Directive 2009/103/EC. The form collects essential information about the accident, including vehicle details, circumstance descriptions, witness statements, and damage assessment, while ensuring compliance with GDPR and Belgian data protection requirements. This standardized document facilitates efficient claims processing and helps ensure all necessary information is gathered at the initial reporting stage, supporting both the insurer's assessment process and the policyholder's claim.
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1. Policyholder Information: Essential details about the insurance policyholder including policy number, name, address, contact information, and policy validity dates
2. Vehicle Details: Comprehensive information about the insured vehicle including make, model, registration number, and current condition
3. Accident Information: Details about when, where, and how the accident occurred, including date, time, location, and weather conditions
4. Damage Description: Detailed description of the damage sustained by the vehicle, including visual documentation references
5. Third Party Information: Details of other parties involved in the accident, including their insurance information
6. Witness Information: Contact details of any witnesses to the accident
7. Police Report: Information about police involvement, including report numbers and responding officer details
8. Declaration: Formal statement confirming the truth of the information provided, including data protection notices and signature section
1. Personal Injury Section: To be included when the accident resulted in injuries to any party, including details of injuries and medical treatment
2. Property Damage Section: For cases involving damage to property other than vehicles
3. Multiple Vehicle Involvement: Additional section for accidents involving more than two vehicles
4. Foreign Jurisdiction Details: Required when accident occurred outside Belgium but within EU coverage area
5. Theft Report: Specific section for claims related to vehicle theft rather than accidents
1. Schedule A - Photograph Log: List and description of all photographs submitted as evidence of damage
2. Schedule B - Repair Estimate: Detailed estimate from approved repair shop or mechanic
3. Schedule C - Additional Documentation: List of supporting documents including police reports, witness statements, and medical reports
4. Appendix 1 - Sketch of Accident: Template for drawing accident scene diagram
5. Appendix 2 - Vehicle Damage Marking Sheet: Diagram template for marking areas of vehicle damage
6. Appendix 3 - Privacy Notice: Detailed information about how personal data will be processed in accordance with GDPR
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