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Reporting an insurance event

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* Leasing contract number:

Vehicle damage (partial damage)
Vehicle destruction (total damage)
Stolen vehicle

* We hereby report to you an insurance event with regard to the above mentioned leasing contract and, at the same time, we ask for your approval with an indemnification payment to:
the lesseethe repair shopUniCredit Leasing CZ, a.s.

* License plate number and vehicle type:
* VAT payer:yesno
* Date of the insurance event (dd.mm.yyyy):
* Insurance event number:
* Damage in CZK, incl. VAT:
* The indemnification will be settled from:
* Address of an insurance company liquidating the claim:
 
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* Mandatory items

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