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1 Notice of accident for vehicles registered abroad Art. 74 of the Swiss Road Traffic Act ( SVG ) in connection with art. 41 Swiss Road Traffic Decree ( VVV ) Questions about foreign car holder and his vehicle Name of owner First name of owner Occupation Home address Address in Switzerland Lenght of stay Name and address of driver Nationality of driver of your vehicle VAT: Are you subject to VAT? yes, inclusive VAT no, net exclusive VAT none Description of your motor vehicle involved in the accident Please sign with a X type of vehicle in question private car jeep delivery van lorry motor-coach motorcycle small motorcycle Make Year of manufacture Chassis no. Engine no. Registration no.: Country, Number Questions about the victim and his vehicle Name of owner First name of owner Occupation Home address Address in Switzerland Lenght of stay - 1 -

2 Name and address of driver Nationality of driver of your vehicle VAT: Are you subject to VAT? yes, inclusive VAT no, net exclusive VAT none Description of your motor vehicle involved in the accident Please sign with a X type of vehicle in question private car jeep delivery van lorry motor-coach motorcycle small motorcycle Make Year of manufacture Chassis no. Engine no. Registration no.: Country, Number Questions about insurance Name and address of foreign owner s Third Party Liability Insurer Legal protection insurance? Name and address of victim s Third Party Liability Insurer Legal protection insurance? Questions to the foreign car holder Do you have an international Motor insurance Card (green card)? If yes, please include it. No. Did you take out a Frontier insurance Policy at the Swiss Customs (blue form)? If yes, please include it. Questions about the accident Date of accident day, month, year, time Plate of accident - 2 -

3 Full particulars of accident Explanatory sketch (Desirable in every case) What was the speed of your vehicle? Are you or your driver in possession of a Since when? Category? valid driving licence? Was the driver of your vehicle in any way to blame for the accident? Was an other party to blame? Who? Why? Motivation Full names, addresses and telephone of all passengers in your vehicle at time of accident? Were passengers being conveyed against payment? - 3 -

4 Names, addresses and telephones of independent witnesses of the accident? (persons not being conveyed in your vehicle) Did the parties filled out an European Accident Report (EAR)? If yes, please include a legible copy. Did the police take particulars of the accident? If so, give name of the police-station To be completed in case Third Parties have been killed or injured Injured or killed persons: name, occupation, address, telephone Status Age Particulars of injury? Is it slight or serious? To be completed in case of damage to property of Third Parties Name, address and telephone of Third Parties Particulars of damage? Registration no. of damaged vehicle: country, number Observations by the undersigned - 4 -

5 In case of property damage? Please sign Authorization here on below: The undersigned hereby authorizes the Swiss National Bureau of Insurance (NBI) and its representatives (art. 41, al.1, Swiss Road Traffic Decree (VVV)) to process any data arising from the claims procedure and to transfer this data to third parties affected by the loss, whether inside or outside Switzerland, in particular to co- and reinsurers, and to the liable foreign primary insurer, whose offices may, depending on the constellations, be located in a country without appropriate data protection, in accordance with data protection law. Decree (VVV)) are hereby authorized to procure all pertinent information from public offices and to inspect official files in the event of a loss. Additionally the Swiss National Bureau of Insurance (NBI) and its representatives (art. 41, al.1, Swiss Road Traffic Decree (VVV)) are authorized in cases of recourse to a liable third party to provide the necessary data to the liable third party or their liability insurer, to enable them to enforce their legal claims. The undersigned has/have the right to request information about any data pertaining to him/her. The undersigned also has/have the right to revoke at any time the authorisation granted by him/her/them. Decree (VVV)) hereby undertakes to treat all information received in strictest confidence. Name and Surname Place and date Claimant s, owner s or driver s signature In case of property damage or personal injury? Please sign Authorization: The undersigned authorize(s) the Swiss National Bureau of Insurance (NBI) and its representatives (art. 41, al.1, Swiss Road Traffic Decree (VVV)) to process to the extent required data derived from the processing of the claim and to pass this information on for processing to third parties affected by the damage in and outside Switzerland, in particular to co- and re-insurance companies, and to the liable foreign primary insurer, whose offices may, depending on the constellations, be located in a country without appropriate data protection, in accordance with the data protection act. The undersigned authorize(s) attending medical staff and their assistants to provide the Swiss National Bureau of Insurance (NBI) and its representatives (art. 41, al.1, Swiss Road Traffic Decree (VVV)) or their medical services with all information required in connection with the accident and the processing of the claim, and thereby releases these persons from their obligation to maintain secrecy for this purpose. Decree (VVV)) are authorized to procure pertinent information from official sources and to inspect official files. Furthermore, the Swiss National Bureau of Insurance (NBI) and its representatives (art. 41, al.1, Swiss Road Traffic Decree (VVV)) is also authorized in the event of recourse to a liable third party to provide the necessary information to the liable third party or their liability insurer to enable them to enforce their legal claims. The undersigned person/s has/have the right to request that the Swiss National Bureau of Insurance (NBI) and its representatives (art. 41, al.1, Swiss Road Traffic Decree (VVV)) provide information in respect of data pertaining to him/her/it. The undersigned also has/have the right to revoke at any time the authorisation granted by him/her/them. Decree (VVV)) undertakes to treat all information received in strictest confidence. Name and Surname Place and date Claimant s, owner s or driver s signature This notice of accident should be addressed to: Swiss National Bureau of Insurance (NBI), P.O. Box, CH-8085 Zürich Please report this accident also to your own MTPL insurance! Notice of accident NBI (SVG 74)

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