Online Accident Manager

Record of damage in accident matters

The use of this form is absolutely free of charge and without any contractual obligations. Your data will be treated confidentially in accordance with legal confidentiality. After your data has been checked by a lawyer, you will be contacted immediately. A precise check is only possible with precise information.

Do you need help filling out the form? kanzlei@imasi.de +49 (0) 431 530 3298

Non-binding inquiry

At this point you can send us data for a claim settlement conveniently and quickly electronically.

The transmission of the data is non-binding and there is no mandate relationship. After we have received the data, we will contact you.

Information that you send to us in this way is transmitted in encrypted form and is therefore not visible to unauthorized third parties!

Please fill in required fields (*)

Damage(*)

Property damage

Personal injury

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Client

Owner

Yes

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Driver

Yes

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First name(*)

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Last name(*)

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E-Mail(*)

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Street, house number(*)

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Post code(*)

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City(*)

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Phone(*)

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Name of workshop

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Callback times(*)

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Legal protection insurance

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Insurance policy number

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Liability insurance

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Fully comprehensive insurance

Yes

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Eligible for input tax deduction

Yes

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Expert opinion commissioned

Yes

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License Plate(*)

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Bank account number

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Bank code

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Opponent

Owner

Yes

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Driver

Yes

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First name

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Last name

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E-Mail

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Street, house number

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Post code

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City

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Phone

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License Plate

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Liability insurance

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Further information on the scene of the accident site

Date

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Time

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Postcode

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Scene of the accident(*)

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Further information on the accident

Police

Yes

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File number

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Police department

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Witnesses present

Yes

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Rear-end collision

Yes

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Right of way violation

Yes

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Turning accident

Yes

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Parking accident

Yes

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Facts

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Power of attorney

Yes, I grant you the power of attorney.

No, I have more questions. Please contact me first!

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Privacy policy

(*)

By submitting the form, I agree to the data collection according to your Privacy policy.

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(*)

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