In the event of an accident it is very important that you and any other party or parties involved complete the accident statement form. Do not rush into completing the form, take your time as this will save any problems later. Use the back of the form to make any additional comments or statements.

1) Fecha del accidente (Date of Accident) – Insert the date and time that the incident happened.

2) Localizacion (Locality) – Enter the place and city of the incident.

3) Victima(s) incluso leve (s) (Injury even if slight) – If anyone is injured in any way mark ¨Si¨ in this box otherwise mark ¨no¨

4) Daños matariales (Material damage) – If any other vehicles other than those shown in the sections A & B are damaged mark ¨si¨otherwise mark ¨no¨ in the first box. If any objects other than vehicles (for example other property) is damaged mark ¨si¨in the second box otherise ¨no¨.

5) Testigos: nombre, direccion, tel (witness details) – If any party not involved in the accident witnessed it please obtain their name, address and contact number and enter in box.

6) Asegurado (Policy holder) – You should enter the full details of the Insurance policy holder

7) Vehicle (Vehicle) – Vehiculo a Motor refers to the vehicle, Remolque refers to any trailer, Marca, Modelo (make & model), Matricular (Registration number) Pais de Matricula (Spain)

8) Aseguradora (Policy Holder) – This information can be found on the insurance certificate.

9) Conductor (Driver) – This is the details of the driver. Nombre (Name), Apellido (Surname), Fecha de nacimiento (Date of Birth), Direccion (Address), País (Country), Telephone/Email (Mobile number and email address), Permiso de conducer Numero (Driving License Number), Categoria (B for car), Permiso valido hasta (License expiry date).

10) Indicar el punto de choque inicial con una fleche (Mark with an arrow the point of initial impact to the vehicle) – Mark ¨X¨where the initial impact happened.

11) Daños apreciados al vehiculo A/B (List and visual damage to the vehicle) – Not all damage can be seen but anything that is visible should be recorded.

12) Circunstancias (Circumstances) – Mark with an X in the box of each of the circumstances applicable to the incident.

13) Croquis del accidente en el momento de la colisión (Sketch a diagram of the scene of the accident in the moment of impact) – Also take photos of the location and damage to both parties or anything else involved.

14) Observaciones (Remarks) – Make any other applicable notes such as if the other party admits liabilityor any other information that you feel may be important.

15) Firma de los conductors (Signature of the drivers) – Both parties need to sign the form. Do not sign the form if you do not completely understand what you are signing.

The following boxes must be completed for each party involved (vehicle A and vehicle B). It does not matter which box is used for which vehicle. The following guide explains what to enter in the column relating to the vehicle you are driving.