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Report damage

Report your damage here

It is required that you report any damages on the next working day, please contact the LeasePlan Driver Contact Centre at telephone number: +31 36 527 27 27.

Below is the accident statement that needs to be completed and confirmed by you. After you have confirmed the details you entered you will receive a confirmation by e-mail. Please read any additional instructions carefully.

Your personal details
Salutations *	Mr Mrs
Initials *
Name *
Date of Birth (dd-mm-yyyy) *
Driving license number *
Issued on (dd-mm-yyyy) *	date on which the license was last renewed
Address
Address *
Number *
Additional info:
Postal code and city *
Telephone number *
E-mailaddress *
Details of your car
Make *
Model *
Type *
Registration number *	enter without separation marks of interspaces
Damage
Date damage occurred (dd-mm-yyyy) *
Time *	Hour Minute
Location *
Cause of damage *	(Click Select and choose the cause in the new window)
Was there another party involved that received damage? This also includes damage to objects such as a crashbarrier, a gate or a lamppost. *
Yes No
Was the Police present? *
Yes No
Did the event take place within the urban area? *
Yes No
Was there any evidence of alcohol use in this accident?  *
Yes No
What was the speed at the moment of the impact? *
kilometres per hour
Location of the damage (on vehicle)  *
Top   Inside Bottom
Damaged parts *  (You can select more than one item by holding the CTRL-button)
bonnet bootlid door side sidewing bumper sidescreen headlight lights indicator licenseplate window(s) rim wheel steeringcolumn radiator crankcase engine exhaust radio lock dashboard upholstery mechanical damage rearviewmirror handle trim seat wiring personal belongings windshield wipers aerial various
Was there another party involved? *
Yes No
Is the license of the other party known, or is the adress known? *
Yes No
Kenteken tegenpartij
Is your car insured via Euro Insurances LTD.? (you´ll find this on your insurance card) *
Yes No
Attention! You must also complete and file the standard European Accident Statement.
Extra information:
Send