Claims Reporting

Here you can use an electronic form to report your insurance claim. The information on how to proceed in the event of an accident, damage to or theft of your vehicle is available here.

Indicated data are required

Claims Reporting Form

Data on Lessee



Damaged vehicle
(The required data about your vehicle can be obtained from your service card)

 Vehicle is:

Service centre (where it will be repaired)

Data on Damage

Investigated by the police:

The detected alcohol:

Data on Counterparty


Vehicle data


To expedite the handling of the claim in respect of your vehicle, we recommend that you always enclose a copy of your driving licence with this report. In addition, you can enclose photographs documenting the damage or a police record.

Unless you do so now, please send a copy of your driving licence by e-mail to or send a legible photocopy to our registered office: ARCHER SHERIDAN, Bavorská 2780/2, 155 00 Praha 5

Souhlasím s poskytnutím osobních údajů firmě ARCHER SHERIDAN a potvrzuji úplnost a pravdivost všech uvedených skutečností.

Údaje budou využity výhradně pro účely zpracování tohoto hlášení a ke komunikaci firmy ARCHER SHERIDAN s Vámi a pojišťovnou.