Follow-up notification of breakdown

In order for us to calculate your benefits as quickly as possible, please complete in full the form below and upload all relevant documents.

Vehicle

Special additions

Is the keeper also the driver?

Date of event

Event

Description of problem

Potential total loss?

Please upload cost summary.

Cost summary*

Upload file

For information on data processing, please consult the data protection provisions of AXA Insurance Ltd / AXA Life Ltd.

Please upload photos of damage, drivers license and breakdown report.

Additional documents

Upload file

For information on data processing, please consult the data protection provisions of AXA Insurance Ltd / AXA Life Ltd.

Country

Title

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