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Report the sale or purchase of a vehicle
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Insurance details
Please write Policy number
Policy series and number *
Notifier’s data
Pesel *
Name *
Surname *
Telephone *
E-mail *
Give us your email so we can send you a confirmation of filing your case
Type of inquiry
Change of personal data
Change of vehicle’s data
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Please fill in only the fields that need to be changed.
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Co-owner’s data
Name
Last Name/Company name
Street
House Number
Flat number
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Please fill in only the fields that need to be changed.
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Vehicle registration date
VIN number
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I consent to the transfer of documents and information related to the execution of the application by means of electronic communication, including telephone and e-mail.
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