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Background information
Event Description
Payment
Claimant
Finish
Motor claim application
Claim type
MTPL
MOD
Owner of Your vehicle
Name, surname / Company:
*
ID / Registration No.:
*
Please enter only numbers
Address (street, house, town):
*
Postcode:
LV-
Telephone:
*
Email :
*
Owner = Holder
The holder of Your vehicle
Name, surname / Company:
*
ID / Registration No.:
*
Please enter only numbers
Address (street, house, town):
*
Postcode:
*
LV-
Telephone:
*
Email :
Your vehicle driver
Driver = Owner
Driver = Holder
Driver = Other
Name, surname / Company:
*
ID / Registration No.:
*
Please enter only numbers
Telephone:
*
Email :
*
Driver`s licence nr.:
*
Your vehicle data
Make:
*
--Please select--
Alfa Romeo
Audi
BMW
Chevrolet
Chrysler
Citroen
Dacia
Dodge
Fiat
Ford
Honda
Hyundai
Isuzu
Jaguar
Jeep
KIA
Land Rover
Lexus
Mazda
Mercedes-Benz
Mini
Mitsubishi
Nissan
Opel
Peugeot
Renault
Seat
Subaru
Suzuki
Škoda
Toyota
Volvo
VW
Other…
Other make:
*
Model:
*
Year:
*
Vehicle reg.nr.:
*
Policy number :
Other parties concerned (if any)
The driver's name, surname:
Driver`s licence nr.:
Make:
--Please select--
Alfa Romeo
Audi
BMW
Chevrolet
Chrysler
Citroen
Dacia
Dodge
Fiat
Ford
Honda
Hyundai
Isuzu
Jaguar
Jeep
KIA
Land Rover
Lexus
Mazda
Mercedes-Benz
Mini
Mitsubishi
Nissan
Opel
Peugeot
Renault
Seat
Subaru
Suzuki
Škoda
Toyota
Volvo
VW
Other make..
Other make..
*
Model:
Vehicle reg.nr.:
*
MTPL policy no.:
Insurance company:
*
Next
Event description
Date of accident:
*
Exact time:
:
Accident city:
*
Address of accident:
*
Accident description (in detail, chronologically):
*
The remaining number of characters:
1500
Damage coused in accident:
*
The remaining number of characters:
400
Accident drawn up:
*
By filling the Agreed Statement
Report to police department
Not issued
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Next
Insurance indemnity information
Vehicle technical status:
*
--Please select--
On the go / can participate in road traffic
NOT on the go / cannot participate in road traffic
Vehicle inspection place address:
*
Claim type:
*
--Please select OCTA or KASKO--
Bank name:
*
--Please select--
ABLV Bank, AS
Baltic International Bank, AS
Baltikums Bank, AS
BIGBANK, AS
Citadele banka, AS
Danske Bank, AS filiāle Latvijā
DnB NORD Banka, AS
Eesti Krediidipank Latvijas filiāle, AS
Expobank, AS
GE Money Bank, AS
Latvijas pasta banka, AS
LTB Bank, AS
Meridian Trade Bank, AS
Nordea Bank, AB Latvijas filiāle
NORVIK BANKA, AS
Pohjola Bank plc filiāle Latvijā
PrivatBank, AS
Reģionālā investīciju banka, AS
Rietumu Banka, AS
SEB banka, AS
SMP Bank, AS
Svenska Handelsbanken AB Latvijas filiāle
Swedbank, AS
TRASTA KOMERCBANKA, AS
UniCredit Bank, AS
Other bank..
Other bank..
*
SWIFT code:
*
Bank Account:
*
Please indicate the location of your vehicle:
Vehicle location:
*
Please choose one service from the Compensa partners, where you will show damages:
Name and address of other service:
*
Service regional place:
*
--Please select--
RĪGA
KURZEME
VIDZEME
ZEMGALE
LATGALE
Service:
*
--Please select--
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Claimant
Name, Surname:
*
ID:
*
-
Please enter only numbers
Telephone:
*
Email :
*
Type of decision:
*
SMS
Email
Letter
I hereby confirm that the information provided by me in this Insurance Claim is true and accurate and I understand that any false or inaccurate information given on my or other person's behalf will affect my right to receive the in-surance indemnity.
I hereby authorize the Insurer to request and use any information and documents that are necessary to determine the insurance indemnity amount.
I confirm that I authorize "Compensa Vienna Insurance Group" ADB Latvijas filiāle, registration No. 40103942087, Vienības gatve 87h, Riga, as a system manager and personal data operator, to process my personal data or personal data of the owner of the subject of insurance and the beneficiary, including sensitive personal data and personal identity (classification) numbers (codes) for the performance of the insurance agreement in accordance with the Personal Data Protection Act and other applicable laws of the Republic of Latvia.
*
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Upload documents and draw schema
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A copy of the vehicle registration certificate
A copy of driver's license
Agreed Statement
Other documents
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