GC Broker

EN DE PL

Notification of damage - Property damage

Damaged property owner:

Damage date:

Damage place:

Approximate value of damaged property:

Name and surname of contact person:

Email address of contact person:

Phone number address of contact person:

Event description:

Damage description:

Offender data – name and surname, company name:

Offender Civil Liability policy number:

Offender insurance company:

Attachments

Offender declaration and event protocol:

Police notes:

Other documents:

Photos:

I agree to the processing of my personal data related to the damage by GetCar Sp. z o.o. in order to handle the reported damage.

Personal Data Administrator - see

GC Broker Sp. z.o.o.
Al. Solidarności 36
25-323 Kielce

tel.: +48 41 340 02 62
mobile: +48 606 789 691

Wykonanie: Producer