Avis damage report



Please fill in as many boxes as possible. Boxes marked * must be completed.

 Rental agreement
 Renter (from the rental agreement)
 Driver of the car
 Information about the Avis car
 When and how did the accident happen
 How did the damage happen
 Reported to the police
 Witnesses
 Third party
 Damage to the Avis car?
 Personal injury
 Information about the injured persons
 Responsibility
 Other information

Rental agreement

Rental agreement no.:
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Renter (from the rental agreement)

Renter's name, address, phone no.*:
Renter's e-mail address:
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Driver of the car

Driver's name, address, phone no. and e-mail:
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Information about the Avis car

Licence plate number and car make*:
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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)*:
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How did the damage happen

Details of the accident*:
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Reported to the police

Has the incident been reported to the police*:
Yes No
If yes - which police station:
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Witnesses

Any witnesses:
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Third party

Any known third party*:
Yes No
If yes, registration no.
Third party's name, address,
insurance company and insurance no.:
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Damage to the Avis car?

The front of the Avis car:
Front bumper
Number plate
Bonnet
Right headlight
Left headlight
Entire front of the car
The right side of the Avis car:
Mirror
Front wing
Front wheel
Front door
Side window
Back door
Panel
Back wing
The left of the Avis car:
Mirror
Front wing
Front wheel
Front door
Side window
Back door
Panel
Back wing
The back of the Avis car:
Back bumper
Drawhook
Number plate
Back panel
Hatch
Window
Entire back of the car
Other damage to the Avis car:
Roof
Equipment
Mechanical parts
All over
Undercarriage
Remarks to damage to the Avis car:
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Personal injury

Who has injuries:
You as the driver
Passenger in the Avis car
Driver of the opponent's car
Cyclist
Pedestrian
Other persons
Which injury:
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Information about the injured persons

Injured persons' names, addresses and age:
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Responsibility

In your oppinion - who is the respnsible party and why:
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Other information

Do you have more information to the damage report:
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