Euro Insurances DAC trading as Ayvens Insurance Ground Floor, Ayvens Central Park | Leopardstown, Dublin 18
Claims representative for Greece LEASEPLAN HELLAS COMMERCIAL VEHICLE LEASING AND FLEET MANAGEMENT SERVICES SINGLE MEMBER SOCIÉTÉ ANONYME A. Papandreou Str. 15124 Maroussi, Athens Tax Office for S.A. Companies, VAT ID: 999599948
Ayvens Insurance
Accident report form Insured party’s details HELLAS COMMERCIAL VEHICLE LEASING AND FLEET MANAGEMENT Insured party: LEASEPLAN SERVICES SINGLE MEMBER SOCIÉTÉ ANONYME (Ayvens Greece) Insurance policy no.: License plate no. Start: End: Use: Color: Vehicle make:
Address: Telephone:
Driver’s full name: Address: Telephone: Date of birth: Driver’s license no.: Start: Driver’s license type:
End:
17 A. Papandreou Str., 15124 Marousi +30 210 610 0050
Accident details Location (street - area):
Accident date: Notification date: Accident time:
Has any police authority been informed?
Yes
No
Police authority name:
Third parties’ details Owner: Insurance company: Color: Address: License plate no.: Vehicle make: Driver: Telephone:
1
2
Owner: Insurance company: Color: Address: License plate no.: Vehicle make: Driver: Telephone:
Witnesses
Bodily injured third parties
Who is at fault, in your opinion
Full name:
Full name:
Telephone:
Telephone:
Me
Both
Full name:
Full name:
Third party
I don’t know
Telephone:
Telephone:
Would you like us to schedule vehicle’s repair?
Accident description For the insured party:
For the third party:
Mark the points of damage
Mark the points of damage
10
1
2
10
1
2
10
1
Yes
2
No, I would like to contact Ayvens at
(+30) 210 6100050 myself, in my own time
9
3
9
3
9
3 In case of repair
Area of service 8
4
8
4
8
4
City: Area:
7
5 6
7
5 6
7
5 6
ZIP: