 | | Rental agreement |
| | Renter (from the rental agreement) |
|
| Renter's name, address, phone no.*: |
|
| | Driver of the car |
|
| Driver's name, address, phone no. and e-mail: |
|
| | Information about the Avis car |
| | When and how did the accident happen |
|
| Where did the accident happen (i.e. road name, city name, country)*: |
|
|
| When did the accident happen (date and time)*: |
|
| | How did the damage happen |
|
| Details of the accident*: |
|
| | Reported to the police |
|
| Has the incident been reported to the police*: |
|
| | Witnesses |
|
| Any witnesses: |
|
| | Third party |
|
| Any known third party*: |
|
|
Third party's name, address,
insurance company and insurance no.: |
|
| | Damage to the Avis car? |
|
| The front of the Avis car: |
|
|
| The right side of the Avis car: |
|
|
| The left of the Avis car: |
|
|
| The back of the Avis car: |
|
|
| Other damage to the Avis car: |
|
|
| Remarks to damage to the Avis car: |
|
| | Personal injury |
|
| Who has injuries: |
|
|
| Which injury: |
|
| | Information about the injured persons |
|
| Injured persons' names, addresses and age: |
|
| | Responsibility |
|
| In your oppinion - who is the respnsible party and why: |
|
| | Other information |
|
| Do you have more information to the damage report: |
|
|
|
Rental agreement