Motor claim form (collision with others) 汽车索赔表格（跟其他人碰撞）

汽车索赔表格（跟其他人碰撞） Motor Accident Claim Form (Collision with others)

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
填写表格前，请先准备好以下资料 Please have the following ready before completing the form

事故细节 Info about the incident案件号码 Police case number您的个人资料 Info about the insured对方的个人资料 Info about the 3rd party所有驾驶者的驾照（照片） Photos of all drivers' licenses所有汽车的车牌/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*
您的联络号码 Your contact number*
您的电邮地址 Your email address*
example@example.com
您的ID / 护照号 Your ID / passport number*
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
现在汽车的所在地址 Current location of your car*

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
其他相关照片（可以选择多个档案）Other relevant photos (multiple selection allowed)*

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 *

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汽车索赔表格 （跟其他人碰撞） Motor Accident Claim Form (Collision with others)