Accident declaration

Contact
Accident
Damage
Overview

License plate*

Last name*

First name

Gender

Male

?

Female

Street and Number

Zip and City*

Country

Language

Phone **

Mobile **

Email*

FR

EN

DE

Please note that by submitting this declaration form, you authorize LeasePlan Luxembourg to use the provided information in the claims handling process, and to convey relevant information to the insurance companies, repairers and other persons necessary for the management of the claim. The information you provide will only be used for the above-mentioned process, and will not be used for marketing purposes.