{"id":3259,"date":"2025-08-19T10:03:31","date_gmt":"2025-08-19T08:03:31","guid":{"rendered":"https:\/\/kvg-bus.de\/stade\/?page_id=3259"},"modified":"2025-11-05T08:44:03","modified_gmt":"2025-11-05T07:44:03","slug":"claims-settlement","status":"publish","type":"page","link":"https:\/\/kvg-bus.de\/stade\/en\/service\/claims-settlement\/","title":{"rendered":"Claims settlement"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"3259\" class=\"elementor elementor-3259\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-08c0d3e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"08c0d3e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-5047921\" data-id=\"5047921\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-35c5b38 elementor-widget elementor-widget-heading\" data-id=\"35c5b38\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">CLAIMS SETTLEMENT FOR ACCIDENTS<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6e0ca06 elementor-widget elementor-widget-text-editor\" data-id=\"6e0ca06\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Have you had an accident with one of our vehicles? No problem, we will be happy to help you.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-dd9bf77 elementor-hidden-mobile\" data-id=\"dd9bf77\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-e746ebe e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"e746ebe\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0770513 elementor-widget elementor-widget-text-editor\" data-id=\"0770513\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>If you have had an accident with KVG, please contact us before taking any further steps. You can download the questionnaire for claimants\u00a0<a href=\"#OnlineformularSchadenabwicklung\">online<\/a><a href=\"#PDFSchadenabwicklung\"> fill in<\/a> or as <a href=\"#PDFSchadenabwicklung\">Download PDF.<\/a> Please enclose all relevant information and documents relating to the accident (e.g. photos, witness statements, police report) with your letter so that we can process your request as quickly as possible.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-47b182e elementor-widget elementor-widget-spacer\" data-id=\"47b182e\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ae9777e e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"ae9777e\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-82d6ea3 elementor-widget elementor-widget-menu-anchor\" data-id=\"82d6ea3\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"OnlineformularSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2a257f1 elementor-widget elementor-widget-heading\" data-id=\"2a257f1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Questionnaire for claimants <\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d5fea73 elementor-widget elementor-widget-elementor-extension-gravity-forms\" data-id=\"d5fea73\" data-element_type=\"widget\" data-widget_type=\"elementor-extension-gravity-forms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_chrome gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_21' style='display:none'>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\"<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\" indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_21'  action='\/stade\/en\/wp-json\/wp\/v2\/pages\/3259' data-formid='21' novalidate data-trp-original-action=\"\/stade\/en\/wp-json\/wp\/v2\/pages\/3259\">\n                        <div class='gform-body gform_body'><div id='gform_fields_21' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_21_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Personal details<\/h3><\/div><div id=\"field_21_3\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_3'>Salutation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_21_3' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Mr<\/option><option value='Frau' >Mrs<\/option><option value='Keine Angabe' >Not specified<\/option><\/select><\/div><\/div><fieldset id=\"field_21_5\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_5'>\n                            \n                            <span id='input_21_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_21_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_5_3' class='gform-field-label gform-field-label--type-sub'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_21_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_5_6' class='gform-field-label gform-field-label--type-sub'>Load<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_21_12\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_12'>Telephone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_12' id='input_21_12' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_13\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_13'>e-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_13' id='input_21_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_21_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_21_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_21_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_6_1' id='input_21_6_1_label' class='gform-field-label gform-field-label--type-sub'>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_21_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_6_3' id='input_21_6_3_label' class='gform-field-label gform-field-label--type-sub'>City centre<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_6.4' id='input_21_6_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_21_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_6_5' id='input_21_6_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_21_6_6_container' >\n                                        <select name='input_6.6' id='input_21_6_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d'Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People's Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People's Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_21_6_6' id='input_21_6_6_label' class='gform-field-label gform-field-label--type-sub'>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Details of the accident<\/h3><\/div><div id=\"field_21_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_14'>Location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_21_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_11\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-seven-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_21_11' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_21_11_2_container'><label for='input_21_11_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_11[]' id='input_21_11_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_21_11_1_container'><label for='input_21_11_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>month<\/label><select name='input_11[]' id='input_21_11_1'   aria-required='true'  ><option value=''>month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_21_11_3_container'><label for='input_21_11_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_11[]' id='input_21_11_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_21_10\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Time<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_21_10'>\n                            <input type='number' name='input_10[]' id='input_21_10_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='true'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_21_10_1'>Hours<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_10[]' id='input_21_10_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_21_10_2'>Minutes<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><div id=\"field_21_67\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_67'>Road\/crossing<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_21_67' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_68'>Line\/travel number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_21_68' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_71'>Bus stop<\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_21_71' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_69'>Bus licence plate<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_21_69' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_70'>Name of driver<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_21_70' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_48\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_48'>Accident description<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_48' id='input_21_48' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_21_76\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_21_76'>File<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_21_76' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_21_76&quot;,&quot;container&quot;:&quot;gform_multifile_upload_21_76&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_21_76&quot;,&quot;filelist&quot;:&quot;gform_preview_21_76&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/stade\\\/?gf_page=e39fd3a7eb4da38&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/stade\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/stade\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;33554432b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:21,&quot;field_id&quot;:76,&quot;_gform_file_upload_nonce_21_76&quot;:&quot;100453c856&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_21_76&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_21_76' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_21_76' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_21_76\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_21_76'>Max. file size: 32 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_21_76'><\/ul> <div id='gform_preview_21_76' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_21_23\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Witnesses<\/h3><\/div><fieldset id=\"field_21_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are there any witnesses?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_81'>\n\t\t\t<div class='gchoice gchoice_21_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Ja'  id='choice_21_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_81_0' id='label_21_81_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Nein'  id='choice_21_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_81_1' id='label_21_81_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_20\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_20'>\n                            \n                            <span id='input_21_20_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.3' id='input_21_20_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_20_3' class='gform-field-label gform-field-label--type-sub'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_20_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.6' id='input_21_20_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_20_6' class='gform-field-label gform-field-label--type-sub'>Load<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_17\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_21_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_21_17_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_17_1' id='input_21_17_1_label' class='gform-field-label gform-field-label--type-sub'>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_21_17_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_17_3' id='input_21_17_3_label' class='gform-field-label gform-field-label--type-sub'>City centre<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_17.4' id='input_21_17_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_21_17_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_17_5' id='input_21_17_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_21_17_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_21\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_21'>Telephone<\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_21_21' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are there any other witnesses?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_80'>\n\t\t\t<div class='gchoice gchoice_21_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Ja'  id='choice_21_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_80_0' id='label_21_80_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Nein'  id='choice_21_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_80_1' id='label_21_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_24\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_24'>\n                            \n                            <span id='input_21_24_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.3' id='input_21_24_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_24_3' class='gform-field-label gform-field-label--type-sub'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_24_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.6' id='input_21_24_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_24_6' class='gform-field-label gform-field-label--type-sub'>Load<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_25\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_21_25' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_25_1_container' >\n                                        <input type='text' name='input_25.1' id='input_21_25_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_25_1' id='input_21_25_1_label' class='gform-field-label gform-field-label--type-sub'>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_25_3_container' >\n                                    <input type='text' name='input_25.3' id='input_21_25_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_25_3' id='input_21_25_3_label' class='gform-field-label gform-field-label--type-sub'>City centre<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_25.4' id='input_21_25_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_25_5_container' >\n                                    <input type='text' name='input_25.5' id='input_21_25_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_25_5' id='input_21_25_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_25.6' id='input_21_25_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_26\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_26'>Telephone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_26' id='input_21_26' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_27\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Police recording<\/h3><\/div><div id=\"field_21_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_28'>Office<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_21_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_82'>Transaction number<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_21_82' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_30\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_21_30' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_30_1_container' >\n                                        <input type='text' name='input_30.1' id='input_21_30_1' value=''    aria-required='false'    \/>\n                                        <label for='input_21_30_1' id='input_21_30_1_label' class='gform-field-label gform-field-label--type-sub'>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_30_3_container' >\n                                    <input type='text' name='input_30.3' id='input_21_30_3' value=''    aria-required='false'    \/>\n                                    <label for='input_21_30_3' id='input_21_30_3_label' class='gform-field-label gform-field-label--type-sub'>City centre<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_30.4' id='input_21_30_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_30_5_container' >\n                                    <input type='text' name='input_30.5' id='input_21_30_5' value=''    aria-required='false'    \/>\n                                    <label for='input_21_30_5' id='input_21_30_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_30.6' id='input_21_30_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_77\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_77'>File<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='33554432' \/><input name='input_77' id='input_21_77' type='file' class='large' aria-describedby=\"gfield_upload_rules_21_77\" onchange='javascript:gformValidateFileSize( this, 33554432 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_21_77'>Max. file size: 32 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_21_77'><\/div> <\/div><\/div><div id=\"field_21_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Material damage<\/h3><\/div><fieldset id=\"field_21_72\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is there damage to property?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_72'>\n\t\t\t<div class='gchoice gchoice_21_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Ja'  id='choice_21_72_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_72_0' id='label_21_72_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Nein'  id='choice_21_72_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_72_1' id='label_21_72_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_32'>What was damaged?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_21_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_33\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Owner (possibly lessor)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_33'>\n                            \n                            <span id='input_21_33_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.3' id='input_21_33_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_33_3' class='gform-field-label gform-field-label--type-sub'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_33_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.6' id='input_21_33_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_33_6' class='gform-field-label gform-field-label--type-sub'>Load<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Entitled to deduct input tax?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_34'>\n\t\t\t<div class='gchoice gchoice_21_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Ja'  id='choice_21_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_34_0' id='label_21_34_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Nein'  id='choice_21_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_34_1' id='label_21_34_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_35\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Damage to motor vehicles - cars, lorries etc. (if available)<\/h3><\/div><fieldset id=\"field_21_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is there damage to a motor vehicle?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_73'>\n\t\t\t<div class='gchoice gchoice_21_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Ja'  id='choice_21_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_73_0' id='label_21_73_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Nein'  id='choice_21_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_73_1' id='label_21_73_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_36\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_36'>Kind<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_21_36' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='PKW (Auto)' >Car (car)<\/option><option value='Nutzfahrzeuge (LKW)' >Commercial vehicles (lorries)<\/option><option value='Zweirad (Roller, Motorrad)' >Two-wheeler (scooter, motorbike)<\/option><option value='Land-\/ Baumaschinen' >Agricultural\/construction machinery<\/option><option value='Wohnmobil\/Wohnwagen' >Motorhome\/caravan<\/option><\/select><\/div><\/div><div id=\"field_21_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_37'>Manufacturer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_21_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_38'>Type<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_21_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_39'>Official licence plate number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_21_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_40'>Insurance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_21_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_41\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Personal injury<\/h3><\/div><fieldset id=\"field_21_74\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are there any personal injuries?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_74'>\n\t\t\t<div class='gchoice gchoice_21_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Ja'  id='choice_21_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_74_0' id='label_21_74_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Nein'  id='choice_21_74_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_74_1' id='label_21_74_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_42\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_42'>Salutation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_21_42' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Mr<\/option><option value='Frau' >Mrs<\/option><option value='Keine Angabe' >Not specified<\/option><\/select><\/div><\/div><fieldset id=\"field_21_43\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_43'>\n                            \n                            <span id='input_21_43_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_43.3' id='input_21_43_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_43_3' class='gform-field-label gform-field-label--type-sub'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_43_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_43.6' id='input_21_43_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_43_6' class='gform-field-label gform-field-label--type-sub'>Load<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_44\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_21_44' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_44_1_container' >\n                                        <input type='text' name='input_44.1' id='input_21_44_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_44_1' id='input_21_44_1_label' class='gform-field-label gform-field-label--type-sub'>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_44_3_container' >\n                                    <input type='text' name='input_44.3' id='input_21_44_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_44_3' id='input_21_44_3_label' class='gform-field-label gform-field-label--type-sub'>City centre<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_44.4' id='input_21_44_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_44_5_container' >\n                                    <input type='text' name='input_44.5' id='input_21_44_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_44_5' id='input_21_44_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_21_44_6_container' >\n                                        <select name='input_44.6' id='input_21_44_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d'Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People's Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People's Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_21_44_6' id='input_21_44_6_label' class='gform-field-label gform-field-label--type-sub'>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_45\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_45'>Telephone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_45' id='input_21_45' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_46\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_46'>e-mail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_46' id='input_21_46' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_21_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_47'>Nature and extent of the injury<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_21_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_49\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Seatbelt fastened?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_49'>\n\t\t\t<div class='gchoice gchoice_21_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Ja'  id='choice_21_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_49_0' id='label_21_49_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_49_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Nein'  id='choice_21_49_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_49_1' id='label_21_49_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_50\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Hospitalisation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_50'>\n\t\t\t<div class='gchoice gchoice_21_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Ja'  id='choice_21_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_50_0' id='label_21_50_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_50_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Nein'  id='choice_21_50_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_50_1' id='label_21_50_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_51'>Which hospital?<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_21_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Did the accident occur on the way to or from work?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_63'>\n\t\t\t<div class='gchoice gchoice_21_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Ja'  id='choice_21_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_63_0' id='label_21_63_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Nein'  id='choice_21_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_63_1' id='label_21_63_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is the injured person covered by statutory pension insurance?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_64'>\n\t\t\t<div class='gchoice gchoice_21_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Ja'  id='choice_21_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_64_0' id='label_21_64_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Nein'  id='choice_21_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_64_1' id='label_21_64_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_75\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Were other people injured?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_75'>\n\t\t\t<div class='gchoice gchoice_21_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Ja'  id='choice_21_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_75_0' id='label_21_75_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Nein'  id='choice_21_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_75_1' id='label_21_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_52\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_52'>Salutation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_52' id='input_21_52' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Mr<\/option><option value='Frau' >Mrs<\/option><option value='Keine Angabe' >Not specified<\/option><\/select><\/div><\/div><fieldset id=\"field_21_53\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_53'>\n                            \n                            <span id='input_21_53_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_53.3' id='input_21_53_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_53_3' class='gform-field-label gform-field-label--type-sub'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_53_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_53.6' id='input_21_53_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_53_6' class='gform-field-label gform-field-label--type-sub'>Load<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_54\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_21_54' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_54_1_container' >\n                                        <input type='text' name='input_54.1' id='input_21_54_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_54_1' id='input_21_54_1_label' class='gform-field-label gform-field-label--type-sub'>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_54_3_container' >\n                                    <input type='text' name='input_54.3' id='input_21_54_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_54_3' id='input_21_54_3_label' class='gform-field-label gform-field-label--type-sub'>City centre<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_54.4' id='input_21_54_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_54_5_container' >\n                                    <input type='text' name='input_54.5' id='input_21_54_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_54_5' id='input_21_54_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_21_54_6_container' >\n                                        <select name='input_54.6' id='input_21_54_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d'Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People's Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People's Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_21_54_6' id='input_21_54_6_label' class='gform-field-label gform-field-label--type-sub'>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_55\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_55'>Telephone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_55' id='input_21_55' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_56\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_56'>e-mail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_56' id='input_21_56' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_21_57\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required 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class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5c4e801 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"5c4e801\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-36c678b\" data-id=\"36c678b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b2809cc elementor-widget elementor-widget-menu-anchor\" data-id=\"b2809cc\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"PDFSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e4620d4 elementor-widget elementor-widget-heading\" data-id=\"e4620d4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Questionnaire for claimants as download<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0d4566f elementor-widget elementor-widget-text-editor\" data-id=\"0d4566f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>If you decide in favour of the written option, please send it to us - preferably by e-mail - to\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e174948 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"e174948\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:versicherung@kvg-bus.de\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">versicherung@kvg-bus.de<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-home-lg-alt\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9a93fa1 elementor-widget elementor-widget-button\" data-id=\"9a93fa1\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/formular-fuer-anspruchsteller_schadensabwicklung-kvg.pdf\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-file-pdf\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">TO THE QUESTIONNAIRE AS PDF<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-52fb571 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"52fb571\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6696002 elementor-widget elementor-widget-spacer\" data-id=\"6696002\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5441c34 elementor-widget elementor-widget-menu-anchor\" data-id=\"5441c34\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"KontaktSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9cb143c elementor-widget elementor-widget-heading\" data-id=\"9cb143c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Your contact to us!<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f95b0ee elementor-widget elementor-widget-text-editor\" data-id=\"f95b0ee\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Do you have any questions or want to tell us something? You can reach us on Thursdays from 8 a.m. to 4 p.m. and Fridays from 8 a.m. to 12 noon.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2de3706 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"2de3706\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"tel:051414870854\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">05141 48708-54<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:versicherung@kvg-bus.de\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">versicherung@kvg-bus.de<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-664b275 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"664b275\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-01313be elementor-widget elementor-widget-spacer\" data-id=\"01313be\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1b75e51 elementor-widget elementor-widget-elementor-extension-gravity-forms\" data-id=\"1b75e51\" data-element_type=\"widget\" data-widget_type=\"elementor-extension-gravity-forms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n                <div class='gf_browser_chrome gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_18' ><form method='post' enctype='multipart\/form-data'  id='gform_18'  action='\/stade\/en\/wp-json\/wp\/v2\/pages\/3259' data-formid='18' novalidate data-trp-original-action=\"\/stade\/en\/wp-json\/wp\/v2\/pages\/3259\">\n                        <div class='gform-body gform_body'><div id='gform_fields_18' 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No problem, we will be happy to help you. If you have had an accident with KVG, please contact us before taking any further steps. You can complete the questionnaire for claimants online or download it as a PDF. Please enclose all relevant information and documents relating to the accident (e.g. photos, witness statements, police report) with your letter so that we can process your request quickly. Questionnaire for claimants \u201e*\u201c indicates required fields Personal details Salutation*MrMrsNo details Surname* First name Surname Telephone*Email* Address* Address City Postcode AfghanistanAlbaniaAlgeriaAmerican-SamoaAmerican Virgin IslandsAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAzerbaijanAustraliaBahamasBahrainBangladeshBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Virgin IslandsBritish Indian Ocean TerritoryBrunei Indian OceanBrunei DarussalamBulgariaBurkina FasoBurundiCaymen IslandsChileChinaCook IslandsCosta RicaCura\u00e7aoC\u00f4te d'IvoireLaos Democratic People's RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEl SalvadorEritreaEstoniaEswatiniFalkland IslandsFijiFinlandFranceFrench GuianaFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic TerritoriesFutuna (Wallis and Futuna)Faroe IslandsGabonGambiaGeorgiaGhanaGibraltarGrenadaGreeceGreat BritainGreenlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonaldIslandsHoly SeeHondurasHong KongIndiaIndonesiaIraqIranIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsKazakhstanKenyaKyrgyzstanKiribatiCocos IslandsCongoCongo, Democratic Republic of theKorea Democratic People's Republic ofCroatiaCubaKuwaitLesothoLatviaLebanonLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMoroccoMarshall-IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMozambiqueMyanmarNamibiaNauruNepalNew CaledoniaNew ZealandNicaraguaNetherlandsNigerNigeriaNiueNorth MacedoniaNorfolk IslandNorwayNorthern Mariana IslandsOmanEast TimorPakistanPalauPalestine, PalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoRwandaRomaniaRussian FederationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre and MiquelonSalomon IslandsZambiaSamoaSan MarinoSaudi ArabiaSwedenSenegalSerbiaSeychellesSierra LeoneZimbabweSingaporeSint MaartenSloveniaSlovakiaSomaliaSpainSri LankaSt. Helena, Ascension and Tristan da CunhaSt. Kitts and NevisSt. LuciaSt. MartinSt. Vincent and the GrenadinesSudanSurinameSvalbard and Jan MayenSyria, Arab RepublicS\u00e3o Tom\u00e9 and Pr\u00edncipeSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanTajikistanTaiwanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoCzech RepublicTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTurkeyUS Minor Outlying IslandsUgandaUkraineHungaryUruguayUsbekistanVanuatuVenezuelaUnited Arab EmiratesUnited States of AmericaVietnamChristmas IslandBelarusWestern SaharaCentral African RepublicCyprusEgypt\u00c4quatorial Guinea\u00c4thiopia\u00c5land IslandsAustria Country Details of the accident Place* Date* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Time* Hours : Minutes Street\/Crossing*Line\/Trip number*StopBus licence plateName Driver Accident signage*File Drag files here or Select files Max. file size 32 MB. File size: 32 MB. Witnesses Are there any witnesses?* Yes No Surname* First name Surname Address* Address City Postcode Telephone Are there any other witnesses?* Yes No Surname* First name Surname Address* Address City Postcode Telephone* Police Recording Department Incident number Address Address City Postcode FileMax. File size: 32 MB. Damage to property Is there any damage to property?* Yes No What was damaged?* Owner (possibly lessor)* First name Last name Entitled to deduct input tax?* Yes No Damage to motor vehicles - cars, lorries, etc. (if any) Is there any damage to a motor vehicle?* Yes No Type*Car (car)Commercial vehicle (lorry)Two-wheeler (scooter, motorbike)Agricultural\/construction machineryMotorhome\/caravanManufacturer*TypeRegistration number*Insurance* Personal injury Is there any personal injury?* Yes No Salutation*MrMrsNo details Surname* First name Surname Address* Address City Postcode AfghanistanAlbaniaAlgeriaAmerican-SamoaAmerican Virgin IslandsAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAzerbaijanAustraliaBahamasBahrainBangladeshBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Virgin IslandsBritish Indian Ocean TerritoryBrunei Indian OceanBrunei DarussalamBulgariaBurkina FasoBurundiCaymen IslandsChileChinaCook IslandsCosta RicaCura\u00e7aoC\u00f4te d'IvoireLaos Democratic People's RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEl SalvadorEritreaEstoniaEswatiniFalkland IslandsFijiFinlandFranceFrench GuianaFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic TerritoriesFutuna (Wallis and Futuna)Faroe IslandsGabonGambiaGeorgiaGhanaGibraltarGrenadaGreeceGreat BritainGreenlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonaldIslandsHoly SeeHondurasHong KongIndiaIndonesiaIraqIranIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsKazakhstanKenyaKyrgyzstanKiribatiCocos IslandsCongoCongo, Democratic Republic of theKorea Democratic People's Republic ofCroatiaCubaKuwaitLesothoLatviaLebanonLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMoroccoMarshall-IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMozambiqueMyanmarNamibiaNauruNepalNew CaledoniaNew ZealandNicaraguaNetherlandsNigerNigeriaNiueNorth MacedoniaNorfolk IslandNorwayNorthern Mariana IslandsOmanEast TimorPakistanPalauPalestine, PalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoRwandaRomaniaRussian FederationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre and MiquelonSalomon IslandsZambiaSamoaSan MarinoSaudi ArabiaSwedenSenegalSerbiaSeychellesSierra LeoneZimbabweSingaporeSint MaartenSloveniaSlovakiaSomaliaSpainSri LankaSt. Helena, Ascension and Tristan da CunhaSt. Kitts and NevisSt. LuciaSt. MartinSt. Vincent and the GrenadinesSudanSurinameSvalbard and Jan MayenSyria, Arab RepublicS\u00e3o Tom\u00e9 and Pr\u00edncipeSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanTajikistanTaiwanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoCzech RepublicTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTurkeyUS Minor Outlying IslandsUgandaUkraineHungaryUruguayUsbekistanVanuatuVenezuelaUnited Arab EmiratesUnited States of AmericaVietnamChristmas IslandBelarusWestern SaharaCentral African RepublicCyprusEgypt\u00c4quatorial Guinea\u00c4thiopia\u00c5land IslandsAustria Country Phone*Email Type and extent of injury* Seatbelt worn? Yes No Hospitalisation* Yes No Which hospital? Did the accident occur on the way to or from work?* Yes No Is the injured person covered by statutory pension insurance? Yes No Were any other persons injured?* Yes No Title*MrMrsNo details Surname* First name Surname Address* Address City Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAmerican Virgin IslandsSamoaAmerican Virgin IslandsAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAzerbaijanAustraliaBahamasBahrainBangladeshBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Virgin IslandsBritish Indian Ocean TerritoryBrunei Indian OceanBrunei DarussalamBulgariaBurkina FasoBurundiCaymen IslandsChileChinaCook IslandsCosta RicaCura\u00e7aoC\u00f4te d'IvoireLaos Democratic People's RepublicDenmarkEcuadorEl SalvadorEritreaEstoniaEswatiniFalkland IslandsFijiFinlandFranceFrench GuianaFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic TerritoriesFutuna (Wallis and Futuna)Faroe IslandsGabonGambiaGeorgiaGhanaGibraltarGrenadaGreeceGreat BritainGreenlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonaldIslandsHoly SeeHondurasHong KongIndiaIndonesiaIraqIranIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsKazakhstanKenyaKyrgyzstanKiribatiCocos IslandsCongoCongo, Democratic Republic of theKorea Democratic People's Republic ofCroatiaCubaKuwaitLesothoLatviaLebanonLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMoroccoMarshall-IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMozambiqueMyanmarNamibiaNauruNepalNew CaledoniaNew ZealandNicaraguaNetherlandsNigerNigeriaNiueNorth MacedoniaNorfolk IslandNorwayNorthern Mariana IslandsOmanEast TimorPakistanPalauPalestine, PalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoRwandaRomaniaRussian FederationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre and MiquelonSalomon IslandsZambiaSamoaSan MarinoSaudi ArabiaSwedenSenegalSerbiaSeychellesSierra LeoneZimbabweSingaporeSint MaartenSloveniaSlovakiaSomaliaSpainSri LankaSt. Helena, Ascension and Tristan da CunhaSt. Kitts and NevisSt. LuciaSt. MartinSt. Vincent and the GrenadinesSudanSurinameSvalbard and Jan MayenSyria, Arab RepublicS\u00e3o Tom\u00e9 and Pr\u00edncipeSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanTajikistanTaiwanTanzania, United Republic ofThailandTogoTokelauTongaTrinidad and TobagoCzech RepublicTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTurkeyUS Minor Outlying IslandsUgandaUkraineHungaryUruguayUsbekistanVanuatuVenezuelaUnited Arab EmiratesUnited States of AmericaVietnamChristmas IslandBelarusWestern SaharaCentral African RepublicCyprusEgypt\u00c4quatorial Guinea\u00c4thiopia\u00c5land IslandsAustria Country Phone*Email Type and extent of injury* Seatbelt worn? Yes No Hospitalisation* Yes No Which hospital? Did the accident occur on the way to or from work?* Yes No Does the injured person have statutory pension insurance? Yes No Consent* I agree to the privacy policy. CAPTCHA questionnaire for claimants as download If you decide in favour of the written option, please send it to us - preferably by e-mail - to versicherung@kvg-bus.de Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle TO THE QUESTIONNAIRE AS PDF Your contact to us! Do you have any questions or want to tell us something? We are available for you on Thursdays from 8 am to 4 pm and Fridays from 8 am to 12 pm. 05141 48708-54 versicherung@kvg-bus.de How do you like our website? OutstandingMostly goodNeutralNot goodFearfulWhich page are you on?(required) Is there anything else you would like to tell us?<\/p>","protected":false},"author":4,"featured_media":1567,"parent":16,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3259","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Schadenabwicklung - KVG Stade<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/kvg-bus.de\/stade\/service\/claims-settlement\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Schadenabwicklung - KVG Stade\" \/>\n<meta property=\"og:description\" content=\"SCHADENABWICKLUNG BEI UNF\u00c4LLEN Du hattest einen Unfall mit einem unserer Fahrzeugen? Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit der KVG hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du\u00a0online ausf\u00fcllen oder als PDF herunterladen. Bitte f\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Zeit* Stunden : Minuten Stra\u00dfe\/Kreuzung*Linie\/Fahrtnummer*HaltestelleBus-KennzeichenName Fahrer\/-inUnfallschilderung*Datei Ziehe Dateien hier her oder W\u00e4hle Dateien aus Max. Dateigr\u00f6\u00dfe: 32 MB. Zeugen Gibt es Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon Gibt es weitere Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon* Polizeiaufnahme DienststelleVorgangsnummer Anschrift Anschrift Stadt PLZ DateiMax. Dateigr\u00f6\u00dfe: 32 MB. Sachsch\u00e4den Liegt eine Sachbesch\u00e4digung vor?* Ja Nein Was wurde besch\u00e4digt?* Eigent\u00fcmer (evtl. Leasinggeber)* Vorname Nachname Vorsteuerabzugsberechtigt?* Ja Nein Besch\u00e4digung an Kraftfahrzeugen &#8211; PKW, LKW etc. (falls vorhanden) Liegt eine Besch\u00e4digung an einem Kraftfahrzeug vor?* Ja Nein Art*PKW (Auto)Nutzfahrzeuge (LKW)Zweirad (Roller, Motorrad)Land-\/ BaumaschinenWohnmobil\/WohnwagenHersteller*TypAmtl. Kennzeichen*Versicherung* Personensch\u00e4den Liegen Personensch\u00e4den vor?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Wurden weitere Personen verletzt?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. 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Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Einwilligung* Ich stimme der Datenschutzerkl\u00e4rung zu. CAPTCHA Fragebogen f\u00fcr Anspruchssteller als Download Solltest du dich f\u00fcr die schriftliche M\u00f6glichkeit entscheide sende uns diesen &#8211; bevorzugt per E-Mail &#8211; an\u00a0 versicherung@kvg-bus.de Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle ZUM FRAGEBOGEN ALS PDF Dein Kontakt zu uns! Du hast Fragen oder m\u00f6chtest uns etwas mitteilen? Wir sind donnerstags von 8 &#8211; 16 Uhr und freitags von 8 &#8211; 12 Uhr f\u00fcr dich erreichbar.\u00a0 05141 48708-54 versicherung@kvg-bus.de Wie gut gef\u00e4llt dir unsere Website?HerausragendVorwiegend gutNeutralNicht gutFurchtbarAuf welcher Seite befindest du dich?(erforderlich) M\u00f6chtest du uns sonst noch etwas sagen?\" \/>\n<meta property=\"og:url\" content=\"https:\/\/kvg-bus.de\/stade\/service\/claims-settlement\/\" \/>\n<meta property=\"og:site_name\" content=\"KVG Stade\" \/>\n<meta property=\"article:modified_time\" content=\"2025-11-05T07:44:03+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1920\" \/>\n\t<meta property=\"og:image:height\" content=\"600\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/kvg-bus.de\/stade\/service\/schadenabwicklung\/\",\"url\":\"https:\/\/kvg-bus.de\/stade\/service\/schadenabwicklung\/\",\"name\":\"Schadenabwicklung - KVG Stade\",\"isPartOf\":{\"@id\":\"https:\/\/kvg-bus.de\/stade\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/kvg-bus.de\/stade\/service\/schadenabwicklung\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/kvg-bus.de\/stade\/service\/schadenabwicklung\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\",\"datePublished\":\"2025-08-19T08:03:31+00:00\",\"dateModified\":\"2025-11-05T07:44:03+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/kvg-bus.de\/stade\/service\/schadenabwicklung\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/kvg-bus.de\/stade\/service\/schadenabwicklung\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\/\/kvg-bus.de\/stade\/service\/schadenabwicklung\/#primaryimage\",\"url\":\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\",\"contentUrl\":\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\",\"width\":1920,\"height\":600},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/kvg-bus.de\/stade\/service\/schadenabwicklung\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Startseite\",\"item\":\"https:\/\/kvg-bus.de\/stade\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Service\",\"item\":\"https:\/\/kvg-bus.de\/stade\/service\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Schadenabwicklung\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/kvg-bus.de\/stade\/#website\",\"url\":\"https:\/\/kvg-bus.de\/stade\/\",\"name\":\"KVG Stade\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/kvg-bus.de\/stade\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/kvg-bus.de\/stade\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/kvg-bus.de\/stade\/#organization\",\"name\":\"KVG Stade\",\"url\":\"https:\/\/kvg-bus.de\/stade\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\/\/kvg-bus.de\/stade\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/kvg_logo-1.svg\",\"contentUrl\":\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/kvg_logo-1.svg\",\"width\":1322,\"height\":404,\"caption\":\"KVG Stade\"},\"image\":{\"@id\":\"https:\/\/kvg-bus.de\/stade\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Claims settlement - KVG Stade","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/kvg-bus.de\/stade\/service\/claims-settlement\/","og_locale":"en_GB","og_type":"article","og_title":"Schadenabwicklung - KVG Stade","og_description":"SCHADENABWICKLUNG BEI UNF\u00c4LLEN Du hattest einen Unfall mit einem unserer Fahrzeugen? Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit der KVG hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du\u00a0online ausf\u00fcllen oder als PDF herunterladen. Bitte f\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Zeit* Stunden : Minuten Stra\u00dfe\/Kreuzung*Linie\/Fahrtnummer*HaltestelleBus-KennzeichenName Fahrer\/-inUnfallschilderung*Datei Ziehe Dateien hier her oder W\u00e4hle Dateien aus Max. Dateigr\u00f6\u00dfe: 32 MB. Zeugen Gibt es Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon Gibt es weitere Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon* Polizeiaufnahme DienststelleVorgangsnummer Anschrift Anschrift Stadt PLZ DateiMax. Dateigr\u00f6\u00dfe: 32 MB. Sachsch\u00e4den Liegt eine Sachbesch\u00e4digung vor?* Ja Nein Was wurde besch\u00e4digt?* Eigent\u00fcmer (evtl. Leasinggeber)* Vorname Nachname Vorsteuerabzugsberechtigt?* Ja Nein Besch\u00e4digung an Kraftfahrzeugen &#8211; PKW, LKW etc. (falls vorhanden) Liegt eine Besch\u00e4digung an einem Kraftfahrzeug vor?* Ja Nein Art*PKW (Auto)Nutzfahrzeuge (LKW)Zweirad (Roller, Motorrad)Land-\/ BaumaschinenWohnmobil\/WohnwagenHersteller*TypAmtl. Kennzeichen*Versicherung* Personensch\u00e4den Liegen Personensch\u00e4den vor?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Wurden weitere Personen verletzt?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. 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