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Request for reimbursement of procedural costs

You have received a summary penalty order or a driver's license suspension, for which procedural costs were incurred? Then use the form below.


Do you want to report a legal case instead of reimbursement of the procedural costs? Then use the form for the case registration.

 

Fields marked * must be completed.

Please enter your policy number.

Title*

Please enter your title.

Please enter your first name.

Please enter your surname.

Please enter a valid date of birth.

Please enter a valid e-mail address.

Please enter your telephone number.

Please enter a valid IBAN number.

Please enter your bank.

Please enter the first name and surname of the account owner.

Please enter the place of residence of the account owner.

Please transmit all relevant documents (all pages of the penalty order and/or order of the road traffic office).

Attach Documents (PDF/JPG, max. 20 MB)*

The maximum size of all files is 20MB.

Files must be .pdf, .jpg or .png only.

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The maximum size of all files is 20MB.

Files must be .pdf, .jpg or .png only.

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The maximum size of all files is 20MB.

Files must be .pdf, .jpg or .png only.

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