Claim form carrier liability insurance

For CMR insurance, railroad cartage insurance (BRVS) and subsidiary insurance (SUB)

The fields marked with * are mandatory and must be filled in!

Policy number

Policyholder

Salutation

First name

Last name

E-Mail

Phone

Claim number

Pos-Nr.

Date of loss

Plate number (of the tractor/motor vehicle)

Name of the driver

Cargo pickup location

Cargo acceptance date

Cargo delivery point

Cargo delivery date

Name of the injured party

Customary designation of the damaged or lost goods

Weight of the goods affected by the damage

Was reloaded on the way, for what reason

Is there a separate transport insurance? If so, with which company?

Damage history

Accident or theft location

From which police station was the recording made?

Currently known amount of damage

Has a survey been arranged and with whom?

Have you already received a written liability notice?

Upload files (multiple files possible)