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Accident Notification

Fill in the form, signed it by hand and send it to your CONCORDIA agency.

Accident reported by

Title

Injured person

Please answer all questions completely and accurately.

Format: 123.45.67.890.1

Work details

Were you employed or undergoing professional training at the time of the accident?

Format: 09:30

Is it a traffic accident?
Was a third party responsible for the accident?
Was a police report filed?

Injuries

Side of body
Wie wurden Sie behandelt? (EN)
Are you unable to work?
Could the medical treatment be concluded in the meantime?

Other insurances

By which of the insurances listed below are you insured against accidents, whether mandatory or supplementary, and to what extent?

Obligatory Accident Insurance UversG/OUFL of the employer
Coverage
School accident insurance
Coverage
In the event of an accident abroad: Was the trip paid for by credit card?
Coverage

General remarks

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