Fill out this form in order to provide us with a detailed explanation of your case.

    Personal Information

    Name of Policy Holder*

    Policy Number*


    ZIP Code, City

    Phone (private)

    Phone (work)

    Damaged Party

    First Name

    Last Name


    ZIP Code, City

    Phone (private)


    Are you related to the damaged party?YesNo

    How are you related?

    Does the damaged party live in a domestic community with you?

    Claim Information

    Which of the insured pets (allegedly) caused the damage?

    Breed and Age of your Animal:

    Shoulder Height of your Animal:

    For how long have you owned the animal?

    When did the incident occur?




    Where did the incident occur?


    ZIP Code, City

    Please describe what happened

    Has the police taken down the incident?YesNo

    Please state the file number:

    Address of the Police Station/Investigating Authorities:

    Were there any witnesses?YesNo

    Witness' Name

    Witness' Address


    ZIP Code, City

    Was the damage caused by the damaged party and is the damaged party at fault?YesNo

    Please give details why:

    Who else has, if only partially, caused the damage?

    Who was in charge of the animal at the time of the accident?

    Did this person observe the general duty of care?YesNo

    Is there any occupational/commercial purpose of the animal?YesNo

    Do dogs have to be on a leash at the place where the incident occured?YesNo

    Do dogs have to wear a muzzle at the place where the incident occured?YesNo

    Was your dog on a leash at the time of the incident?YesNo

    Was the other dog on a leash at the time of the incident?YesNo

    Breed of the other Dog:

    Is there any property damage?YesNo

    Which third-party goods have been damaged? (Please also indicate manner and extent of the damages?

    In which condition were the damaged goods?NewOldWell-MaintainedFaulty

    Age and Purchase Price of damaged Goods in EUR:

    Can the damage be repaired?YesNo

    Estimated Costs of Repair

    Have you or the other person who caused the damage rented, leased or borrowed the damaged goods or were they part of a special safekeeping contract?YesNo

    Has the use of the damaged good been permitted?YesNo

    Is there any personal damage?YesNo

    Name of Injured Parties



    ZIP Code, City

    Age of Injured People

    Relationship StatusSingleMarriedDivorcedWidowed

    Kind of Injury

    Profession and Employer of Injured Person

    If available, please upload relevant documents/images here:

    Important Advice

    Please fill in and return this claims report truthfully and completely. Deliberate or incomplete information can lead to the complete loss of the insurance benefit. Gross negligently untrue information can lead to a reduction of the insurance benefit proportional to the degree of your negligence unless this information is unnecessary for the determination of the insurance insured event or for the determination or the extent of our obligation to perform.