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Claim form

You get the car claim form when you purchase car insurance.

All about the claim form

The car claim form is given to you when you purchase car insurance. You should always keep this claim form in your car from then on. It is even better to have two in case you get involved in a chain collision or accidentally get involved in 2 car claims in 1 day.

The claim form can also be used when you have damage with a moped or motorcycle.

Also read our tips on how to fill out a claim form or what the dramatic consequences can be if you fill out a claim form incorrectly.

How do I get a claim form?

When you take out a car insurance policy, you will receive a claim form together with the policy. Keep this in the car so that you always have it to hand when you have a claim. Do you no longer have the claim form? Then you can request it from your agent or insurance company. You can also download and print the claim form here.

When to fill in a claim form?

You fill in the claim form when you are involved in an accident, for example when you knock off the mirror of another car or when another driver bumps into you. It is best to fill in the claim form immediately after the accident, because then you can remember best exactly what happened. It is wise to fill in the front of the claim form together with the other party. Both parties need a completed form to send to their insurer. You can fill in the back of the form at home if you wish. It will mainly contain your personal details.

How to fill in a claim form?

Filling out the claim form correctly is very important. A mistake while filling it out can slow down process, resulting in a slower claim settlement. Therefore, it is important that you fill out the form immediately after the accident. Therefore, always have a claim form in your glove box. That way you can be sure that you fill out the form completely and correctly. To get you started, we have made a video explaining step by step how to fill out a claim form

Download FREE claim form through Alpina

Download a European claim form here.

Frequently asked questions about the claim form

Can filling out a proper claim form speed up the process?

If you no longer have a claim form, please request a new form from your insurer or your agent. You can also download a claim form from our website. If you have any questions about the form or any other subject, please do not hesitate to contact us. We will be pleased to help you.

How do I fill in a claim form?

Have you been involved in a collision? Then you must fill in the claim form together with the other party. You do this on the spot, immediately after the accident. That way everything is still fresh in your mind and you can fill in the form correctly. The form has a front and a back. You only need to fill in the front together with the other party. You can also fill in the back of the form at home. Then send the claim form to your insurer. We will explain both sides of the form below.

What should I do at the front of a claim form?

On the front of the claim form you will see the numbers 1 to 15. For each number there is information that you and the other party must fill in. Go through all the steps calmly and fill in everything as completely as possible.

Also clearly discuss with the other party who fills in their details under vehicle A, and who under vehicle B. At number 6, the details of the policyholder are requested. Number 9 asks for the driver's details. For number 9, you should always fill in the details of the driver at the time of the collision. Was your vehicle parked at the time of the collision and no one was present? Then you cannot fill in the driver's details.

In the middle of the form you will see number 12, indicated as "reason". Here you can tick the appropriate box or boxes. This makes it much clearer for the insurance company to assess how the collision happened. At the bottom of the form, at number 14, marked "my comments", both parties can give a brief explanation.

Once all the information has been completed and both parties agree with what is written on the form, the form should be signed by both persons. After signing, the original can be torn off from the reprint so that both parties involved have their own form.

claim form

What to do on the back of a claim form?

Completing the back of the claim form is often forgotten by insureds. Yet it is very important for the insurance company that the back side is filled out. Filling out the back side can be done quietly at home. You do not need the other party for this. By filling out the back of the form, it makes the claim form become your form.

A lot of information is requested on the back of the claim form, but not everything is equally important. The most important eight points to be filled in are the following:

  1. Policyholder
  2. Driver
  3. Damage to your motor vehicle
  4. Police
  5. Victims
  6. Circumstances of occurrence
  7. Liability
  8. Date and signature

Please make sure that you fill in all the information covered by these points. For example: The data that fall under policyholder are name, account number, profession, employment/self-employment and right to deduct VAT.

If you have also completed the back of the form, you can send it to your insurance company or insurance agent. They will then be able to deal with your claim.

claim form

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Recovery service

Alpina works together with to recover non-covered damage from the other party or the guarantee fund. Has someone caused damage to you but you have no coverage on your own policy, then can help you recover your damage from the other party completely free of charge.


More terms claim form

Car damage form

When you take out a car insurance policy, you will receive a European claim form from the insurer. It is wise to keep this in the glove compartment of your car so that you always have it to hand. You have to fill in this form together with the other party after an accident. On the basis of this completed form, the insurer can determine who is at fault and the amount of the claim that must be paid out. This claim form looks the same throughout Europe, only the language differs per country, of course. You can therefore use the form throughout Europe.

Buy a claim form

You will receive the claim form when you purchase your car insurance. Have you lost the claim form or perhaps you have already used it once? Then you do not need to buy a new claim form. You can simply download this for free on our website. It is wise to do this right away and store the claim form in your car. This way you will always have it at hand. Nowadays, you can also use the mobile app in case of damage. That way you don't have to fill out a form, just answer the questions in the app. You can also add photos of the damage.

Online claim form

Lost your claim form? You can also download it online. Unfortunately you cannot fill it in online. However, you can report the damage online via the mobile app. The claim form consists of 14 questions. These are questions about the accident and the damage, but also about the vehicles involved and their drivers. If you use the app, you can upload photos so that the insurer can see the damage with their own eyes. This is great, because this way the other party cannot claim later that the damage reported is not correct. Your insurer is automatically notified when you report car damage via the mobile app.

Calculate car insurance premium directly

Now with free recovery service
  • To calculate premiums, we need the zip code of the primary driver. For private use, the youngest driver must reside at the same address as the applicant. In case of business use, you can enter the postal code of the company here.

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