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About the vehicle involved into an accident
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Accident Statement
If the road traffic accident has taken place in a foreign country
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About the vehicle involved into an accident
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In order to submit an insurance claim electronically, you must activate "Java Script" in your web browser.
An explanation to be submitted by the holder of the MTPL policy of Seesam, who is blamed for causing the traffic accident.
Claimant
First name, Family name*
Personal code*
Address*
Post code
Phone*
E-mail
Accident date, time (dd.mm.yyyy)*
Accident place (city, rural district/parish, street, house No.)*
Vehicle owner
First name Family name / Name of the agency*
Personal code / VAT Reg. No.
Address
Post code
Phone
E-mail
Vehicle driver
First name, Family name*
Personal code*
Address*
Post code
Phone*
E-mail
Driver’s license No.
Issued on/date
Category
Accident registered by police
No
Yes
Protocol No
Agreed upon statement filled out at the scene of accident
No
Yes
Info about Your vehicle
MTPLI / OCTA policy series No.
Vehicle make, model
State reg. No.*
Description of the accident
Layout of the accident
Your vehicle visible damage after the road traffic accident
If the damaged property cannot be presented at any of the customer service offices of AAS "Seesam Latvija" (
service offices
),please specify the location where it might be inspected during working hours
Address, phone, contact person
Attached documents
Max 500 Kb
Max 500 Kb
Max 500 Kb
Max 500 Kb
Max 500 Kb
Please wait! Data processing takes place.
Only when a message appears on the screen and a copy of your claim is received in your e-mail box, your claim has been sent successfully.
Warning!
Claim sending failed! Please try again by pressing the button "Send it again!"
With this I undertake to provide all the information at my disposal regarding the mentioned event, as well as co-operate to obtain additional information necessary for reviewing this insurance claim.
If the information regarding the conditions of the event provided by me is delusive or false, or if the orders of the insurer will not be followed, the insurance indemnity will be decreased or rejected.
I certify that the information provided is true*
*Fill fields, which is marked with asterisk!
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