挡风玻璃理赔 Windscreen Claim

挡风玻璃理赔 Windscreen Claim

请耐心地填写这个问卷，提供最详细和正确的资料，我们才可以完善地处理您的索赔 Kindly complete this form and provide detailed and accurate information, so that we can handle your claim effectively
事故细节 Info about the incident
您的个人资料 Info about the insured
驾驶者的驾照（照片） Photos of all drivers' licenses
汽车的车牌/行车证（照片）Photos of registration # / License disc
汽车损毁照片 Photos of all damages
受保人的资料 Info about the insured
车主／投保人／投保公司的英文姓名 Full name of owner / insured*
身份证/护照号码ID/passport number*
联系电话 Contact number*
电子邮件 Email address*
example@example.com
汽车品牌和型号 Car make & model*
汽车还能开，不会造成更多损毁？Can the car be driven without causing further damages?*

是 Yes不是 No
哪个窗户坏了 Which window is damaged ?*

正面 Front后窗 Back前驾驶员侧 Front driver side后驾驶员侧 Back driver side前排乘客侧 Front passenger side后乘客侧 Back passenger sideOther
现在汽车的所在地址 Current location of car*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
行车证或注册证书照片 Photo of License Disc *

上载 Upload

Cancelof
事故资料 Info about the incident
事发日期 Date of the incident*

MonthDayYear
Date
事发时间 Time of the incident*

:HourMinutesAM/PM Option
事发地點 Place of the incident*
道路状况 Road condition*

晴天 Clear sky下雨 Rainy大雾 Misty黑暗 Dark
事发经过的详细内容 Detailed description of the incident*
照片 Photos
汽车损毁照片（可以选择多个档案） Photo of damages (multiple selection allowed)*

上载多个档案 Upload multiple files

Cancelof
其他相关资料（例如维修报价） Other relevant info (e.g. repair quote)

上载多个档案 Upload multiple files

Cancelof
宣言和签名 Declaration & signature

我在此确认以上资料正确无误，如果还有其他对保障有影响的额外资料，我会尽快提供给我的保险顾问和公司。I hereby declare the foregoing particular to be true in every aspect. If there are additional information that may have a material impact on the policy, I will inform my advisor and insurer as soon as possible
受保人的签名 Signature by the insured

Clear
Should be Empty:

挡风玻璃 理赔 Windscreen Claim

受保人的资料 Info about the insured

事故资料 Info about the incident

照片 Photos

宣言和签名 Declaration & signature

挡风玻璃理赔 Windscreen Claim