{"id":3246,"date":"2025-10-14T15:36:11","date_gmt":"2025-10-14T13:36:11","guid":{"rendered":"https:\/\/vb-bachstein.de\/hornburg\/?page_id=3246"},"modified":"2026-09-03T15:07:18","modified_gmt":"2026-09-03T13:07:18","slug":"dla-firm-2","status":"publish","type":"page","link":"https:\/\/vb-bachstein.de\/hornburg\/pl\/service\/fuer-unternehmen\/","title":{"rendered":"Rozliczanie roszcze\u0144"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3246\" class=\"elementor elementor-3246\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-17c8c62 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no\" data-id=\"17c8c62\" data-element_type=\"section\" data-e-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-2a83dbb\" data-id=\"2a83dbb\" data-element_type=\"column\" data-e-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-2968a3e elementor-widget elementor-widget-heading\" data-id=\"2968a3e\" data-element_type=\"widget\" data-e-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\">SCHADENSABWICKLUNG BEI UNF\u00c4LLEN<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5da35ce elementor-widget elementor-widget-text-editor\" data-id=\"5da35ce\" data-element_type=\"widget\" data-e-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>Du hattest einen Unfall mit einem unserer Fahrzeuge? Kein Problem wir helfen dir gerne weiter.<\/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-3e0d994 elementor-hidden-mobile\" data-id=\"3e0d994\" data-element_type=\"column\" data-e-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-ce0a0ba e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"ce0a0ba\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-73bcb84 elementor-widget elementor-widget-text-editor\" data-id=\"73bcb84\" data-element_type=\"widget\" data-e-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>Wenn du einen Unfall mit einem unserer Fahrzeuge hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du <a href=\"#OnlineformularSchadenabwicklung\">online<\/a><a href=\"#PDFSchadenabwicklung\"> ausf\u00fcllen<\/a> oder als <a href=\"#PDFSchadenabwicklung\">PDF herunterladen.<\/a> Bitte f\u00fcge deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen.<\/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-6ef1374 elementor-widget elementor-widget-spacer\" data-id=\"6ef1374\" data-element_type=\"widget\" data-e-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-5442887 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"5442887\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f7eb7fb elementor-widget elementor-widget-menu-anchor\" data-id=\"f7eb7fb\" data-element_type=\"widget\" data-e-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-683cb81 elementor-widget elementor-widget-heading\" data-id=\"683cb81\" data-element_type=\"widget\" data-e-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\">Fragebogen f\u00fcr Anspruchsteller <\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d49dab1 elementor-widget elementor-widget-elementor-extension-gravity-forms\" data-id=\"d49dab1\" data-element_type=\"widget\" data-e-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>\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 Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var 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<\/script>\n\n                <div class='gf_browser_gecko 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'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; oznacza pola wymagane<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_21'  action='\/hornburg\/pl\/wp-json\/wp\/v2\/pages\/3246' data-formid='21' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_21' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><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\" data-group-id=\"939ff093\" data-field-span=\"12\"><h3 class=\"gsection_title\">Pers\u00f6nliche Angaben<\/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\" data-group-id=\"1ac4d083\" data-field-span=\"3\"><label id='gfield_label_21_3' class='gfield_label gform-field-label' for='input_21_3'><span class='gform-field-label__text'>Anrede<\/span><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' >Herr<\/option><option value='Frau' >Frau<\/option><option value='Keine Angabe' >Keine Angabe<\/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\" data-group-id=\"1ac4d083\" data-field-span=\"9\"><legend id='gfield_label_21_5' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><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'     aria-labelledby=\"input_21_5_3_label gfield_label_21_5\"\/>\n                                                    <label for='input_21_5_3' id='input_21_5_3_label' class='gform-field-label gform-field-label--type-sub '>Imi\u0119<\/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' id='input_21_5_6_label' class='gform-field-label gform-field-label--type-sub '>Nazwisko<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_21_12\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7d6a5992\" data-field-span=\"6\"><label id='gfield_label_21_12' class='gfield_label gform-field-label' for='input_21_12'><span class='gform-field-label__text'>Telefon<\/span><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\" data-group-id=\"7d6a5992\" data-field-span=\"6\"><label id='gfield_label_21_13' class='gfield_label gform-field-label' for='input_21_13'><span class='gform-field-label__text'>E-Mail<\/span><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\" data-group-id=\"3fe07045\" data-field-span=\"12\"><legend id='gfield_label_21_6' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Anschrift<\/span><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'    aria-labelledby=\"input_21_6_1_label gfield_label_21_6\"\/>\n                                        <label for='input_21_6_1' id='input_21_6_1_label' class='gform-field-label gform-field-label--type-sub '>Ulica<\/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 '>Miasto<\/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 '>Kod pocztowy<\/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='AF' >Afganistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algieria<\/option><option value='AD' >Andora<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarktyda<\/option><option value='AG' >Antigua i Barbuda<\/option><option value='SA' >Arabia Saudyjska<\/option><option value='AR' >Argentyna<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbejd\u017can<\/option><option value='BS' >Bahamy<\/option><option value='BH' >Bahrajn<\/option><option value='BD' >Bangladesz<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermudy<\/option><option value='BT' >Bhutan<\/option><option value='BY' >Bia\u0142oru\u015b<\/option><option value='BO' >Boliwia<\/option><option value='BQ' >Bonaire, St Eustatius i Saba<\/option><option value='BA' >Bo\u015bnia i Hercegowina<\/option><option value='BW' >Botswana<\/option><option value='BR' >Brazylia<\/option><option value='BN' >Brunei Darussalam<\/option><option value='IO' >Brytyjskie Terytorium Oceanu Indyjskiego<\/option><option value='BG' >Bu\u0142garia<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CL' >Chile<\/option><option value='CN' >Chiny<\/option><option value='HR' >Chorwacja<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cypr<\/option><option value='TD' >Czad<\/option><option value='ME' >Czarnog\u00f3ra<\/option><option value='CZ' >Czechy<\/option><option value='DK' >Dania<\/option><option value='CD' >Demokratyczna Republika Kongo<\/option><option value='DM' >Dominikana<\/option><option value='DO' >Dominikana, Republika<\/option><option value='DJ' >D\u017cibuti<\/option><option value='EG' >Egipt<\/option><option value='EC' >Ekwador<\/option><option value='ER' >Erytrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini (Suazi)<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falklandy<\/option><option value='RU' >Federacja Rosyjska<\/option><option value='FJ' >Fid\u017ci<\/option><option value='PH' >Filipiny<\/option><option value='FI' >Finlandia<\/option><option value='FR' >Francja<\/option><option value='TF' >Francuskie Terytoria Po\u0142udniowe<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Grecja<\/option><option value='GD' >Grenada<\/option><option value='GL' >Grenlandia<\/option><option value='GE' >Gruzja<\/option><option value='GU' >Guam<\/option><option value='GG' >Guernsey<\/option><option value='GY' >Gujana<\/option><option value='GF' >Gujana Francuska<\/option><option value='GP' >Gwadelupa<\/option><option value='GT' >Gwatemala<\/option><option value='GN' >Gwinea<\/option><option value='GW' >Gwinea Bissau<\/option><option value='GQ' >Gwinea R\u00f3wnikowa<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='ES' >Hiszpania<\/option><option value='NL' >Holandia<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hongkong<\/option><option value='IN' >Indie<\/option><option value='ID' >Indonezja<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irlandia<\/option><option value='IS' >Islandia<\/option><option value='IL' >Izrael<\/option><option value='JM' >Jamajka<\/option><option value='JP' >Japonia<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordania<\/option><option value='KY' >Kajmany<\/option><option value='KH' >Kambod\u017ca<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='QA' >Katar<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='KG' >Kirgistan<\/option><option value='KI' >Kiribati<\/option><option value='CO' >Kolumbia<\/option><option value='KM' >Komory<\/option><option value='CG' >Kongo<\/option><option value='KR' >Korea Po\u0142udniowa<\/option><option value='KP' >Korea\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='CR' >Kostaryka<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwejt<\/option><option value='LA' >Laota\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='LS' >Lesoto<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libia<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litwa<\/option><option value='LU' >Luksemburg<\/option><option value='LV' >\u0141otwa<\/option><option value='MG' >Madagaskar<\/option><option value='YT' >Majotta<\/option><option value='MO' >Makau<\/option><option value='MW' >Malawi<\/option><option value='MV' >Malediwy<\/option><option value='MY' >Malezja<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MP' >Mariany P\u00f3\u0142nocne<\/option><option value='MA' >Maroko<\/option><option value='MQ' >Martynika<\/option><option value='MR' >Mauretania<\/option><option value='MU' >Mauritius<\/option><option value='MX' >Meksyk<\/option><option value='FM' >Mikronezja<\/option><option value='MM' >Mjanma<\/option><option value='MD' >Mo\u0142dawia<\/option><option value='MC' >Monako<\/option><option value='MN' >Mongolia<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambik<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='DE' >Niemcy<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NI' >Nikaragua<\/option><option value='NU' >Niue<\/option><option value='NO' >Norwegia<\/option><option value='NC' >Nowa Kaledonia<\/option><option value='NZ' >Nowa Zelandia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestyna<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Nowa Gwinea<\/option><option value='PY' >Paragwaj<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PF' >Polinezja Francuska<\/option><option value='PL' >Polska<\/option><option value='ZA' >Po\u0142udniowa Afryka<\/option><option value='PR' >Portoryko<\/option><option value='PT' >Portugalia<\/option><option value='MK' >P\u00f3\u0142nocna Macedonia<\/option><option value='CF' >Republika Afryki \u015arodkowej<\/option><option value='CV' >Republika Zielonego Przyl\u0105dka<\/option><option value='RE' >Reunion<\/option><option value='RO' >Rumunia<\/option><option value='RW' >Rwanda<\/option><option value='EH' >Sahara Zachodnia<\/option><option value='KN' >Saint Kitts i Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre i Miquelon<\/option><option value='VC' >Saint Vincent i Grenadyny<\/option><option value='BL' >Saint-Barth\u00e9lemy<\/option><option value='MF' >Saint-Martin<\/option><option value='SV' >Salwador<\/option><option value='WS' >Samoa<\/option><option value='AS' >Samoa Ameryka\u0144ska<\/option><option value='SM' >San Marino<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seszele<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapur<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >S\u0142owacja<\/option><option value='SI' >S\u0142owenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='LK' >Sri Lanka<\/option><option value='US' >Stany Zjednoczone<\/option><option value='VA' >Stolica Apostolska<\/option><option value='SD' >Sudan<\/option><option value='SS' >Sudan Po\u0142udniowy<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard i Jan Mayen<\/option><option value='SY' >Syryjska Republika Arabska<\/option><option value='CH' >Szwajcaria<\/option><option value='SE' >Szwecja<\/option><option value='TJ' >Tad\u017cykistan<\/option><option value='TH' >Tajlandia<\/option><option value='TW' >Tajwan<\/option><option value='TZ' >Tanzania, Zjednoczona Republika<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trynidad i Tobago<\/option><option value='TN' >Tunezja<\/option><option value='TR' >Turcja<\/option><option value='TM' >Turkmenistan<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraina<\/option><option value='UY' >Urugwaj<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='WF' >Wallis i Futuna<\/option><option value='VE' >Wenezuela<\/option><option value='HU' >W\u0119gry<\/option><option value='VN' >Wietnam<\/option><option value='IT' >W\u0142ochy<\/option><option value='CI' >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value='CX' >Wyspa Bo\u017cego Narodzenia<\/option><option value='IM' >Wyspa Man<\/option><option value='NF' >Wyspa Norfolk<\/option><option value='SH' >Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha<\/option><option value='AX' >Wyspy Alandzkie<\/option><option value='BV' >Wyspy Bouvet<\/option><option value='CK' >Wyspy Cooka<\/option><option value='VI' >Wyspy Dziewicze, U.S.A.<\/option><option value='VG' >Wyspy Dziewicze, Wielka Brytania<\/option><option value='CC' >Wyspy Kokosowe<\/option><option value='MH' >Wyspy Marshalla<\/option><option value='FO' >Wyspy Owcze<\/option><option value='SB' >Wyspy Salomona<\/option><option value='ST' >Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca<\/option><option value='TC' >Wyspy Turks i Caicos<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AE' >Zjednoczone Emiraty Arabskie<\/option><option value='GB' >Zjednoczone Kr\u00f3lestwo<\/option><\/select>\n                                        <label for='input_21_6_6' id='input_21_6_6_label' class='gform-field-label gform-field-label--type-sub '>Kraj<\/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\" data-group-id=\"58fe1876\" data-field-span=\"12\"><h3 class=\"gsection_title\">Angaben zum Unfall<\/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\" data-group-id=\"88d7c6fc\" data-field-span=\"12\"><label id='gfield_label_21_14' class='gfield_label gform-field-label' for='input_21_14'><span class='gform-field-label__text'>Ort<\/span><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\" data-group-id=\"12feaed5\" data-field-span=\"7\"><legend id='gfield_label_21_11' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Datum<\/span><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' id='input_21_11_2_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Tag<\/label><select name='input_11[]' id='input_21_11_2'   aria-required='true'   aria-labelledby=\"input_21_11_2_label gfield_label_21_11\" ><option value=''>Tag<\/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' id='input_21_11_1_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Monat<\/label><select name='input_11[]' id='input_21_11_1'   aria-required='true'  ><option value=''>Monat<\/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' id='input_21_11_3_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jahr<\/label><select name='input_11[]' id='input_21_11_3'   aria-required='true'  ><option value=''>Jahr<\/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\" data-group-id=\"12feaed5\" data-field-span=\"5\"><legend id='gfield_label_21_10' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Zeit<\/span><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='GG' aria-required='true'    aria-labelledby=\"input_21_10_1_label gfield_label_21_10\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_21_10_1' id='input_21_10_1_label'>Godziny<\/label>\n                        <\/div>\n                        <div class=\"above 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' id='input_21_10_2_label'>Minut(y)<\/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\" data-group-id=\"3c0d6b17\" data-field-span=\"4\"><label id='gfield_label_21_67' class='gfield_label gform-field-label' for='input_21_67'><span class='gform-field-label__text'>Stra\u00dfe\/Kreuzung<\/span><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\" data-group-id=\"3c0d6b17\" data-field-span=\"4\"><label id='gfield_label_21_68' class='gfield_label gform-field-label' for='input_21_68'><span class='gform-field-label__text'>Linie\/Fahrtnummer<\/span><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\" data-group-id=\"3c0d6b17\" data-field-span=\"4\"><label id='gfield_label_21_71' class='gfield_label gform-field-label' for='input_21_71'><span class='gform-field-label__text'>Haltestelle<\/span><\/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\" data-group-id=\"25b41cee\" data-field-span=\"6\"><label id='gfield_label_21_69' class='gfield_label gform-field-label' for='input_21_69'><span class='gform-field-label__text'>Bus-Kennzeichen<\/span><\/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\" data-group-id=\"25b41cee\" data-field-span=\"6\"><label id='gfield_label_21_70' class='gfield_label gform-field-label' for='input_21_70'><span class='gform-field-label__text'>Name Fahrer\/-in<\/span><\/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\" data-group-id=\"4efbcbcf\" data-field-span=\"12\"><label id='gfield_label_21_48' class='gfield_label gform-field-label' for='input_21_48'><span class='gform-field-label__text'>Unfallschilderung<\/span><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\" data-group-id=\"586c4bfd\" data-field-span=\"12\"><label id='gfield_label_21_76' class='gfield_label gform-field-label' for='gform_browse_button_21_76'><span class='gform-field-label__text'>Datei<\/span><\/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:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/?gf_page=e39fd3a7eb4da38&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Akceptowane pliki&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;d64d4e034f&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'>Upu\u015b\u0107 pliki tutaj lub <\/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\"  >Wybierz pliki<\/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'>Maks. rozmiar pliku: 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\" data-group-id=\"62821a7e\" data-field-span=\"12\"><h3 class=\"gsection_title\">Zeugen<\/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 gfield--choice-align-vertical\" data-group-id=\"88d68c81\" data-field-span=\"12\"><legend id='gfield_label_21_81' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Gibt es Zeugen?<\/span><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 )'  aria-labelledby=\"label_21_81_0 gfield_label_21_81\"   \/>\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'>Ja<\/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'>Nein<\/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\" data-group-id=\"e0336470\" data-field-span=\"4\"><legend id='gfield_label_21_20' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><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'     aria-labelledby=\"input_21_20_3_label gfield_label_21_20\"\/>\n                                                    <label for='input_21_20_3' id='input_21_20_3_label' class='gform-field-label gform-field-label--type-sub '>Imi\u0119<\/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' id='input_21_20_6_label' class='gform-field-label gform-field-label--type-sub '>Nazwisko<\/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\" data-group-id=\"e0336470\" data-field-span=\"4\"><legend id='gfield_label_21_17' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Anschrift<\/span><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'    aria-labelledby=\"input_21_17_1_label gfield_label_21_17\"\/>\n                                        <label for='input_21_17_1' id='input_21_17_1_label' class='gform-field-label gform-field-label--type-sub '>Ulica<\/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 '>Miasto<\/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 '>Kod pocztowy<\/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--phone-format-international gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"e0336470\" data-field-span=\"4\"><label id='gfield_label_21_21' class='gfield_label gform-field-label' for='input_21_21'><span class='gform-field-label__text'>Telefon<\/span><\/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 gfield--choice-align-vertical\" data-group-id=\"d8194e5c\" data-field-span=\"12\"><legend id='gfield_label_21_80' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Gibt es weitere Zeugen?<\/span><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 )'  aria-labelledby=\"label_21_80_0 gfield_label_21_80\"   \/>\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'>Ja<\/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'>Nein<\/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\" data-group-id=\"81fe94f2\" data-field-span=\"4\"><legend id='gfield_label_21_24' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><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'     aria-labelledby=\"input_21_24_3_label gfield_label_21_24\"\/>\n                                                    <label for='input_21_24_3' id='input_21_24_3_label' class='gform-field-label gform-field-label--type-sub '>Imi\u0119<\/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' id='input_21_24_6_label' class='gform-field-label gform-field-label--type-sub '>Nazwisko<\/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\" data-group-id=\"81fe94f2\" data-field-span=\"4\"><legend id='gfield_label_21_25' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Anschrift<\/span><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'    aria-labelledby=\"input_21_25_1_label gfield_label_21_25\"\/>\n                                        <label for='input_21_25_1' id='input_21_25_1_label' class='gform-field-label gform-field-label--type-sub '>Ulica<\/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 '>Miasto<\/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 '>Kod pocztowy<\/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--phone-format-international gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"81fe94f2\" data-field-span=\"4\"><label id='gfield_label_21_26' class='gfield_label gform-field-label' for='input_21_26'><span class='gform-field-label__text'>Telefon<\/span><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\" data-group-id=\"da102e86\" data-field-span=\"12\"><h3 class=\"gsection_title\">Polizeiaufnahme<\/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\" data-group-id=\"7b12c995\" data-field-span=\"12\"><label id='gfield_label_21_28' class='gfield_label gform-field-label' for='input_21_28'><span class='gform-field-label__text'>Dienststelle<\/span><\/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\" data-group-id=\"73cc5b99\" data-field-span=\"12\"><label id='gfield_label_21_82' class='gfield_label gform-field-label' for='input_21_82'><span class='gform-field-label__text'>Vorgangsnummer<\/span><\/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\" data-group-id=\"58f371af\" data-field-span=\"12\"><legend id='gfield_label_21_30' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Anschrift<\/span><\/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'    aria-labelledby=\"input_21_30_1_label gfield_label_21_30\"\/>\n                                        <label for='input_21_30_1' id='input_21_30_1_label' class='gform-field-label gform-field-label--type-sub '>Ulica<\/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 '>Miasto<\/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 '>Kod pocztowy<\/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\" data-group-id=\"5368d4b5\" data-field-span=\"12\"><label id='gfield_label_21_77' class='gfield_label gform-field-label' for='input_21_77'><span class='gform-field-label__text'>Datei<\/span><\/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'>Maks. rozmiar pliku: 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\" data-group-id=\"2d34e958\" data-field-span=\"12\"><h3 class=\"gsection_title\">Sachsch\u00e4den<\/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 gfield--choice-align-vertical\" data-group-id=\"a28b9bc9\" data-field-span=\"12\"><legend id='gfield_label_21_72' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Liegt eine Sachbesch\u00e4digung vor?<\/span><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 )'  aria-labelledby=\"label_21_72_0 gfield_label_21_72\"   \/>\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'>Ja<\/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'>Nein<\/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\" data-group-id=\"24fd8cfe\" data-field-span=\"12\"><label id='gfield_label_21_32' class='gfield_label gform-field-label' for='input_21_32'><span class='gform-field-label__text'>Was wurde besch\u00e4digt?<\/span><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\" data-group-id=\"71cdde83\" data-field-span=\"12\"><legend id='gfield_label_21_33' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Eigent\u00fcmer (evtl. Leasinggeber)<\/span><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'     aria-labelledby=\"input_21_33_3_label gfield_label_21_33\"\/>\n                                                    <label for='input_21_33_3' id='input_21_33_3_label' class='gform-field-label gform-field-label--type-sub '>Imi\u0119<\/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' id='input_21_33_6_label' class='gform-field-label gform-field-label--type-sub '>Nazwisko<\/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 gfield--choice-align-vertical\" data-group-id=\"1c613068\" data-field-span=\"12\"><legend id='gfield_label_21_34' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Vorsteuerabzugsberechtigt?<\/span><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 )'  aria-labelledby=\"label_21_34_0 gfield_label_21_34\"   \/>\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'>Ja<\/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'>Nein<\/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\" data-group-id=\"df1361c7\" data-field-span=\"12\"><h3 class=\"gsection_title\">Besch\u00e4digung an Kraftfahrzeugen - PKW, LKW etc. (falls vorhanden)<\/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 gfield--choice-align-vertical\" data-group-id=\"f3db7fc8\" data-field-span=\"12\"><legend id='gfield_label_21_73' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Liegt eine Besch\u00e4digung an einem Kraftfahrzeug vor?<\/span><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 )'  aria-labelledby=\"label_21_73_0 gfield_label_21_73\"   \/>\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'>Ja<\/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'>Nein<\/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\" data-group-id=\"455100b5\" data-field-span=\"4\"><label id='gfield_label_21_36' class='gfield_label gform-field-label' for='input_21_36'><span class='gform-field-label__text'>Art<\/span><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)' >PKW (Auto)<\/option><option value='Nutzfahrzeuge (LKW)' >Nutzfahrzeuge (LKW)<\/option><option value='Zweirad (Roller, Motorrad)' >Zweirad (Roller, Motorrad)<\/option><option value='Land-\/ Baumaschinen' >Land-\/ Baumaschinen<\/option><option value='Wohnmobil\/Wohnwagen' >Wohnmobil\/Wohnwagen<\/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\" data-group-id=\"455100b5\" data-field-span=\"4\"><label id='gfield_label_21_37' class='gfield_label gform-field-label' for='input_21_37'><span class='gform-field-label__text'>Hersteller<\/span><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\" data-group-id=\"455100b5\" data-field-span=\"4\"><label id='gfield_label_21_38' class='gfield_label gform-field-label' for='input_21_38'><span class='gform-field-label__text'>Typ<\/span><\/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\" data-group-id=\"41e484e6\" data-field-span=\"6\"><label id='gfield_label_21_39' class='gfield_label gform-field-label' for='input_21_39'><span class='gform-field-label__text'>Amtl. Kennzeichen<\/span><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\" data-group-id=\"41e484e6\" data-field-span=\"6\"><label id='gfield_label_21_40' class='gfield_label gform-field-label' for='input_21_40'><span class='gform-field-label__text'>Versicherung<\/span><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\" data-group-id=\"9d6e9e06\" data-field-span=\"12\"><h3 class=\"gsection_title\">Personensch\u00e4den<\/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 gfield--choice-align-vertical\" data-group-id=\"867c133c\" data-field-span=\"12\"><legend id='gfield_label_21_74' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Liegen Personensch\u00e4den vor?<\/span><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 )'  aria-labelledby=\"label_21_74_0 gfield_label_21_74\"   \/>\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'>Ja<\/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'>Nein<\/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\" data-group-id=\"4633a602\" data-field-span=\"3\"><label id='gfield_label_21_42' class='gfield_label gform-field-label' for='input_21_42'><span class='gform-field-label__text'>Anrede<\/span><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' >Herr<\/option><option value='Frau' >Frau<\/option><option value='Keine Angabe' >Keine Angabe<\/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\" data-group-id=\"4633a602\" data-field-span=\"9\"><legend id='gfield_label_21_43' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><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'     aria-labelledby=\"input_21_43_3_label gfield_label_21_43\"\/>\n                                                    <label for='input_21_43_3' id='input_21_43_3_label' class='gform-field-label gform-field-label--type-sub '>Imi\u0119<\/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' id='input_21_43_6_label' class='gform-field-label gform-field-label--type-sub '>Nazwisko<\/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\" data-group-id=\"a47b9f6b\" data-field-span=\"12\"><legend id='gfield_label_21_44' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Anschrift<\/span><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'    aria-labelledby=\"input_21_44_1_label gfield_label_21_44\"\/>\n                                        <label for='input_21_44_1' id='input_21_44_1_label' class='gform-field-label gform-field-label--type-sub '>Ulica<\/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 '>Miasto<\/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 '>Kod pocztowy<\/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='AF' >Afganistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algieria<\/option><option value='AD' >Andora<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarktyda<\/option><option value='AG' >Antigua i Barbuda<\/option><option value='SA' >Arabia Saudyjska<\/option><option value='AR' >Argentyna<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbejd\u017can<\/option><option value='BS' >Bahamy<\/option><option value='BH' >Bahrajn<\/option><option value='BD' >Bangladesz<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermudy<\/option><option value='BT' >Bhutan<\/option><option value='BY' >Bia\u0142oru\u015b<\/option><option value='BO' >Boliwia<\/option><option value='BQ' >Bonaire, St Eustatius i Saba<\/option><option value='BA' >Bo\u015bnia i Hercegowina<\/option><option value='BW' >Botswana<\/option><option value='BR' >Brazylia<\/option><option value='BN' >Brunei Darussalam<\/option><option value='IO' >Brytyjskie Terytorium Oceanu Indyjskiego<\/option><option value='BG' >Bu\u0142garia<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CL' >Chile<\/option><option value='CN' >Chiny<\/option><option value='HR' >Chorwacja<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cypr<\/option><option value='TD' >Czad<\/option><option value='ME' >Czarnog\u00f3ra<\/option><option value='CZ' >Czechy<\/option><option value='DK' >Dania<\/option><option value='CD' >Demokratyczna Republika Kongo<\/option><option value='DM' >Dominikana<\/option><option value='DO' >Dominikana, Republika<\/option><option value='DJ' >D\u017cibuti<\/option><option value='EG' >Egipt<\/option><option value='EC' >Ekwador<\/option><option value='ER' >Erytrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini (Suazi)<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falklandy<\/option><option value='RU' >Federacja Rosyjska<\/option><option value='FJ' >Fid\u017ci<\/option><option value='PH' >Filipiny<\/option><option value='FI' >Finlandia<\/option><option value='FR' >Francja<\/option><option value='TF' >Francuskie Terytoria Po\u0142udniowe<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Grecja<\/option><option value='GD' >Grenada<\/option><option value='GL' >Grenlandia<\/option><option value='GE' >Gruzja<\/option><option value='GU' >Guam<\/option><option value='GG' >Guernsey<\/option><option value='GY' >Gujana<\/option><option value='GF' >Gujana Francuska<\/option><option value='GP' >Gwadelupa<\/option><option value='GT' >Gwatemala<\/option><option value='GN' >Gwinea<\/option><option value='GW' >Gwinea Bissau<\/option><option value='GQ' >Gwinea R\u00f3wnikowa<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='ES' >Hiszpania<\/option><option value='NL' >Holandia<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hongkong<\/option><option value='IN' >Indie<\/option><option value='ID' >Indonezja<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irlandia<\/option><option value='IS' >Islandia<\/option><option value='IL' >Izrael<\/option><option value='JM' >Jamajka<\/option><option value='JP' >Japonia<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordania<\/option><option value='KY' >Kajmany<\/option><option value='KH' >Kambod\u017ca<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='QA' >Katar<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='KG' >Kirgistan<\/option><option value='KI' >Kiribati<\/option><option value='CO' >Kolumbia<\/option><option value='KM' >Komory<\/option><option value='CG' >Kongo<\/option><option value='KR' >Korea Po\u0142udniowa<\/option><option value='KP' >Korea\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='CR' >Kostaryka<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwejt<\/option><option value='LA' >Laota\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='LS' >Lesoto<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libia<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litwa<\/option><option value='LU' >Luksemburg<\/option><option value='LV' >\u0141otwa<\/option><option value='MG' >Madagaskar<\/option><option value='YT' >Majotta<\/option><option value='MO' >Makau<\/option><option value='MW' >Malawi<\/option><option value='MV' >Malediwy<\/option><option value='MY' >Malezja<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MP' >Mariany P\u00f3\u0142nocne<\/option><option value='MA' >Maroko<\/option><option value='MQ' >Martynika<\/option><option value='MR' >Mauretania<\/option><option value='MU' >Mauritius<\/option><option value='MX' >Meksyk<\/option><option value='FM' >Mikronezja<\/option><option value='MM' >Mjanma<\/option><option value='MD' >Mo\u0142dawia<\/option><option value='MC' >Monako<\/option><option value='MN' >Mongolia<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambik<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='DE' >Niemcy<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NI' >Nikaragua<\/option><option value='NU' >Niue<\/option><option value='NO' >Norwegia<\/option><option value='NC' >Nowa Kaledonia<\/option><option value='NZ' >Nowa Zelandia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestyna<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Nowa Gwinea<\/option><option value='PY' >Paragwaj<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PF' >Polinezja Francuska<\/option><option value='PL' >Polska<\/option><option value='ZA' >Po\u0142udniowa Afryka<\/option><option value='PR' >Portoryko<\/option><option value='PT' >Portugalia<\/option><option value='MK' >P\u00f3\u0142nocna Macedonia<\/option><option value='CF' >Republika Afryki \u015arodkowej<\/option><option value='CV' >Republika Zielonego Przyl\u0105dka<\/option><option value='RE' >Reunion<\/option><option value='RO' >Rumunia<\/option><option value='RW' >Rwanda<\/option><option value='EH' >Sahara Zachodnia<\/option><option value='KN' >Saint Kitts i Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre i Miquelon<\/option><option value='VC' >Saint Vincent i Grenadyny<\/option><option value='BL' >Saint-Barth\u00e9lemy<\/option><option value='MF' >Saint-Martin<\/option><option value='SV' >Salwador<\/option><option value='WS' >Samoa<\/option><option value='AS' >Samoa Ameryka\u0144ska<\/option><option value='SM' >San Marino<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seszele<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapur<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >S\u0142owacja<\/option><option value='SI' >S\u0142owenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='LK' >Sri Lanka<\/option><option value='US' >Stany Zjednoczone<\/option><option value='VA' >Stolica Apostolska<\/option><option value='SD' >Sudan<\/option><option value='SS' >Sudan Po\u0142udniowy<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard i Jan Mayen<\/option><option value='SY' >Syryjska Republika Arabska<\/option><option value='CH' >Szwajcaria<\/option><option value='SE' >Szwecja<\/option><option value='TJ' >Tad\u017cykistan<\/option><option value='TH' >Tajlandia<\/option><option value='TW' >Tajwan<\/option><option value='TZ' >Tanzania, Zjednoczona Republika<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trynidad i Tobago<\/option><option value='TN' >Tunezja<\/option><option value='TR' >Turcja<\/option><option value='TM' >Turkmenistan<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraina<\/option><option value='UY' >Urugwaj<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='WF' >Wallis i Futuna<\/option><option value='VE' >Wenezuela<\/option><option value='HU' >W\u0119gry<\/option><option value='VN' >Wietnam<\/option><option value='IT' >W\u0142ochy<\/option><option value='CI' >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value='CX' >Wyspa Bo\u017cego Narodzenia<\/option><option value='IM' >Wyspa Man<\/option><option value='NF' >Wyspa Norfolk<\/option><option value='SH' >Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha<\/option><option value='AX' >Wyspy Alandzkie<\/option><option value='BV' >Wyspy Bouvet<\/option><option value='CK' >Wyspy Cooka<\/option><option value='VI' >Wyspy Dziewicze, U.S.A.<\/option><option value='VG' >Wyspy Dziewicze, Wielka Brytania<\/option><option value='CC' >Wyspy Kokosowe<\/option><option value='MH' >Wyspy Marshalla<\/option><option value='FO' >Wyspy Owcze<\/option><option value='SB' >Wyspy Salomona<\/option><option value='ST' >Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca<\/option><option value='TC' >Wyspy Turks i Caicos<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AE' >Zjednoczone Emiraty Arabskie<\/option><option value='GB' >Zjednoczone Kr\u00f3lestwo<\/option><\/select>\n                                        <label for='input_21_44_6' id='input_21_44_6_label' class='gform-field-label gform-field-label--type-sub '>Kraj<\/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--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"55c9c756\" data-field-span=\"6\"><label id='gfield_label_21_45' class='gfield_label gform-field-label' for='input_21_45'><span class='gform-field-label__text'>Telefon<\/span><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\" data-group-id=\"55c9c756\" data-field-span=\"6\"><label id='gfield_label_21_46' class='gfield_label gform-field-label' for='input_21_46'><span class='gform-field-label__text'>E-Mail<\/span><\/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\" data-group-id=\"6e0c73fe\" data-field-span=\"12\"><label id='gfield_label_21_47' class='gfield_label gform-field-label' for='input_21_47'><span class='gform-field-label__text'>Art und Umfang der Verletzung<\/span><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 gfield--choice-align-vertical\" data-group-id=\"a5ec7986\" data-field-span=\"4\"><legend id='gfield_label_21_49' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Sicherheitsgurt angelegt?<\/span><\/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 )'  aria-labelledby=\"label_21_49_0 gfield_label_21_49\"   \/>\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'>Ja<\/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'>Nein<\/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 gfield--choice-align-vertical\" data-group-id=\"a5ec7986\" data-field-span=\"4\"><legend id='gfield_label_21_50' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Krankenhausaufenthalt?<\/span><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 )'  aria-labelledby=\"label_21_50_0 gfield_label_21_50\"   \/>\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'>Ja<\/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'>Nein<\/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\" data-group-id=\"a5ec7986\" data-field-span=\"4\"><label id='gfield_label_21_51' class='gfield_label gform-field-label' for='input_21_51'><span class='gform-field-label__text'>Welches Krankenhaus?<\/span><\/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 gfield--choice-align-vertical\" data-group-id=\"d7e0a817\" data-field-span=\"6\"><legend id='gfield_label_21_63' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?<\/span><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 )'  aria-labelledby=\"label_21_63_0 gfield_label_21_63\"   \/>\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'>Ja<\/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'>Nein<\/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 gfield--choice-align-vertical\" data-group-id=\"d7e0a817\" data-field-span=\"6\"><legend id='gfield_label_21_64' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Ist der Verletzte gesetzlich rentenversichert?<\/span><\/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 )'  aria-labelledby=\"label_21_64_0 gfield_label_21_64\"   \/>\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'>Ja<\/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'>Nein<\/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 gfield--choice-align-vertical\" data-group-id=\"14cda005\" data-field-span=\"12\"><legend id='gfield_label_21_75' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Wurden weitere Personen verletzt?<\/span><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 )'  aria-labelledby=\"label_21_75_0 gfield_label_21_75\"   \/>\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'>Ja<\/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'>Nein<\/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\" data-group-id=\"b08db87a\" data-field-span=\"6\"><label id='gfield_label_21_52' class='gfield_label gform-field-label' for='input_21_52'><span class='gform-field-label__text'>Anrede<\/span><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' >Herr<\/option><option value='Frau' >Frau<\/option><option value='Keine Angabe' >Keine Angabe<\/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\" data-group-id=\"b08db87a\" data-field-span=\"6\"><legend id='gfield_label_21_53' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><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'     aria-labelledby=\"input_21_53_3_label gfield_label_21_53\"\/>\n                                                    <label for='input_21_53_3' id='input_21_53_3_label' class='gform-field-label gform-field-label--type-sub '>Imi\u0119<\/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' id='input_21_53_6_label' class='gform-field-label gform-field-label--type-sub '>Nazwisko<\/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\" data-group-id=\"88e5dd9c\" data-field-span=\"12\"><legend id='gfield_label_21_54' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Anschrift<\/span><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'    aria-labelledby=\"input_21_54_1_label gfield_label_21_54\"\/>\n                                        <label for='input_21_54_1' id='input_21_54_1_label' class='gform-field-label gform-field-label--type-sub '>Ulica<\/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 '>Miasto<\/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 '>Kod pocztowy<\/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='AF' >Afganistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algieria<\/option><option value='AD' >Andora<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarktyda<\/option><option value='AG' >Antigua i Barbuda<\/option><option value='SA' >Arabia Saudyjska<\/option><option value='AR' >Argentyna<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbejd\u017can<\/option><option value='BS' >Bahamy<\/option><option value='BH' >Bahrajn<\/option><option value='BD' >Bangladesz<\/option><option value='BB' >Barbados<\/option><option value='BE' >Belgia<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermudy<\/option><option value='BT' >Bhutan<\/option><option value='BY' >Bia\u0142oru\u015b<\/option><option value='BO' >Boliwia<\/option><option value='BQ' >Bonaire, St Eustatius i Saba<\/option><option value='BA' >Bo\u015bnia i Hercegowina<\/option><option value='BW' >Botswana<\/option><option value='BR' >Brazylia<\/option><option value='BN' >Brunei Darussalam<\/option><option value='IO' >Brytyjskie Terytorium Oceanu Indyjskiego<\/option><option value='BG' >Bu\u0142garia<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CL' >Chile<\/option><option value='CN' >Chiny<\/option><option value='HR' >Chorwacja<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cypr<\/option><option value='TD' >Czad<\/option><option value='ME' >Czarnog\u00f3ra<\/option><option value='CZ' >Czechy<\/option><option value='DK' >Dania<\/option><option value='CD' >Demokratyczna Republika Kongo<\/option><option value='DM' >Dominikana<\/option><option value='DO' >Dominikana, Republika<\/option><option value='DJ' >D\u017cibuti<\/option><option value='EG' >Egipt<\/option><option value='EC' >Ekwador<\/option><option value='ER' >Erytrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini (Suazi)<\/option><option value='ET' >Etiopia<\/option><option value='FK' >Falklandy<\/option><option value='RU' >Federacja Rosyjska<\/option><option value='FJ' >Fid\u017ci<\/option><option value='PH' >Filipiny<\/option><option value='FI' >Finlandia<\/option><option value='FR' >Francja<\/option><option value='TF' >Francuskie Terytoria Po\u0142udniowe<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Grecja<\/option><option value='GD' >Grenada<\/option><option value='GL' >Grenlandia<\/option><option value='GE' >Gruzja<\/option><option value='GU' >Guam<\/option><option value='GG' >Guernsey<\/option><option value='GY' >Gujana<\/option><option value='GF' >Gujana Francuska<\/option><option value='GP' >Gwadelupa<\/option><option value='GT' >Gwatemala<\/option><option value='GN' >Gwinea<\/option><option value='GW' >Gwinea Bissau<\/option><option value='GQ' >Gwinea R\u00f3wnikowa<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='ES' >Hiszpania<\/option><option value='NL' >Holandia<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hongkong<\/option><option value='IN' >Indie<\/option><option value='ID' >Indonezja<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irlandia<\/option><option value='IS' >Islandia<\/option><option value='IL' >Izrael<\/option><option value='JM' >Jamajka<\/option><option value='JP' >Japonia<\/option><option value='YE' >Jemen<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordania<\/option><option value='KY' >Kajmany<\/option><option value='KH' >Kambod\u017ca<\/option><option value='CM' >Kamerun<\/option><option value='CA' >Kanada<\/option><option value='QA' >Katar<\/option><option value='KZ' >Kazachstan<\/option><option value='KE' >Kenia<\/option><option value='KG' >Kirgistan<\/option><option value='KI' >Kiribati<\/option><option value='CO' >Kolumbia<\/option><option value='KM' >Komory<\/option><option value='CG' >Kongo<\/option><option value='KR' >Korea Po\u0142udniowa<\/option><option value='KP' >Korea\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='CR' >Kostaryka<\/option><option value='CU' >Kuba<\/option><option value='KW' >Kuwejt<\/option><option value='LA' >Laota\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='LS' >Lesoto<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libia<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Litwa<\/option><option value='LU' >Luksemburg<\/option><option value='LV' >\u0141otwa<\/option><option value='MG' >Madagaskar<\/option><option value='YT' >Majotta<\/option><option value='MO' >Makau<\/option><option value='MW' >Malawi<\/option><option value='MV' >Malediwy<\/option><option value='MY' >Malezja<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MP' >Mariany P\u00f3\u0142nocne<\/option><option value='MA' >Maroko<\/option><option value='MQ' >Martynika<\/option><option value='MR' >Mauretania<\/option><option value='MU' >Mauritius<\/option><option value='MX' >Meksyk<\/option><option value='FM' >Mikronezja<\/option><option value='MM' >Mjanma<\/option><option value='MD' >Mo\u0142dawia<\/option><option value='MC' >Monako<\/option><option value='MN' >Mongolia<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambik<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='DE' >Niemcy<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NI' >Nikaragua<\/option><option value='NU' >Niue<\/option><option value='NO' >Norwegia<\/option><option value='NC' >Nowa Kaledonia<\/option><option value='NZ' >Nowa Zelandia<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestyna<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua Nowa Gwinea<\/option><option value='PY' >Paragwaj<\/option><option value='PE' >Peru<\/option><option value='PN' >Pitcairn<\/option><option value='PF' >Polinezja Francuska<\/option><option value='PL' >Polska<\/option><option value='ZA' >Po\u0142udniowa Afryka<\/option><option value='PR' >Portoryko<\/option><option value='PT' >Portugalia<\/option><option value='MK' >P\u00f3\u0142nocna Macedonia<\/option><option value='CF' >Republika Afryki \u015arodkowej<\/option><option value='CV' >Republika Zielonego Przyl\u0105dka<\/option><option value='RE' >Reunion<\/option><option value='RO' >Rumunia<\/option><option value='RW' >Rwanda<\/option><option value='EH' >Sahara Zachodnia<\/option><option value='KN' >Saint Kitts i Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='PM' >Saint Pierre i Miquelon<\/option><option value='VC' >Saint Vincent i Grenadyny<\/option><option value='BL' >Saint-Barth\u00e9lemy<\/option><option value='MF' >Saint-Martin<\/option><option value='SV' >Salwador<\/option><option value='WS' >Samoa<\/option><option value='AS' >Samoa Ameryka\u0144ska<\/option><option value='SM' >San Marino<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seszele<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapur<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >S\u0142owacja<\/option><option value='SI' >S\u0142owenia<\/option><option value='SO' >Somalia<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='LK' >Sri Lanka<\/option><option value='US' >Stany Zjednoczone<\/option><option value='VA' >Stolica Apostolska<\/option><option value='SD' >Sudan<\/option><option value='SS' >Sudan Po\u0142udniowy<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard i Jan Mayen<\/option><option value='SY' >Syryjska Republika Arabska<\/option><option value='CH' >Szwajcaria<\/option><option value='SE' >Szwecja<\/option><option value='TJ' >Tad\u017cykistan<\/option><option value='TH' >Tajlandia<\/option><option value='TW' >Tajwan<\/option><option value='TZ' >Tanzania, Zjednoczona Republika<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trynidad i Tobago<\/option><option value='TN' >Tunezja<\/option><option value='TR' >Turcja<\/option><option value='TM' >Turkmenistan<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraina<\/option><option value='UY' >Urugwaj<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='WF' >Wallis i Futuna<\/option><option value='VE' >Wenezuela<\/option><option value='HU' >W\u0119gry<\/option><option value='VN' >Wietnam<\/option><option value='IT' >W\u0142ochy<\/option><option value='CI' >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value='CX' >Wyspa Bo\u017cego Narodzenia<\/option><option value='IM' >Wyspa Man<\/option><option value='NF' >Wyspa Norfolk<\/option><option value='SH' >Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha<\/option><option value='AX' >Wyspy Alandzkie<\/option><option value='BV' >Wyspy Bouvet<\/option><option value='CK' >Wyspy Cooka<\/option><option value='VI' >Wyspy Dziewicze, U.S.A.<\/option><option value='VG' >Wyspy Dziewicze, Wielka Brytania<\/option><option value='CC' >Wyspy Kokosowe<\/option><option value='MH' >Wyspy Marshalla<\/option><option value='FO' >Wyspy Owcze<\/option><option value='SB' >Wyspy Salomona<\/option><option value='ST' >Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca<\/option><option value='TC' >Wyspy Turks i Caicos<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AE' >Zjednoczone Emiraty Arabskie<\/option><option value='GB' >Zjednoczone Kr\u00f3lestwo<\/option><\/select>\n                                        <label for='input_21_54_6' id='input_21_54_6_label' class='gform-field-label gform-field-label--type-sub '>Kraj<\/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--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0a8d619a\" data-field-span=\"6\"><label id='gfield_label_21_55' class='gfield_label gform-field-label' for='input_21_55'><span class='gform-field-label__text'>Telefon<\/span><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\" data-group-id=\"0a8d619a\" data-field-span=\"6\"><label id='gfield_label_21_56' class='gfield_label gform-field-label' for='input_21_56'><span class='gform-field-label__text'>E-Mail<\/span><\/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 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b6c1822b\" data-field-span=\"12\"><label id='gfield_label_21_57' class='gfield_label gform-field-label' for='input_21_57'><span class='gform-field-label__text'>Art und Umfang der Verletzung<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_21_57' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_58\" 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 gfield--choice-align-vertical\" data-group-id=\"70bb9312\" data-field-span=\"4\"><legend id='gfield_label_21_58' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Sicherheitsgurt angelegt?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_58'>\n\t\t\t<div class='gchoice gchoice_21_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Ja'  id='choice_21_58_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_21_58_0 gfield_label_21_58\"   \/>\n\t\t\t\t\t<label for='choice_21_58_0' id='label_21_58_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Nein'  id='choice_21_58_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_21_58_1' id='label_21_58_1' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_59\" 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 gfield--choice-align-vertical\" data-group-id=\"70bb9312\" data-field-span=\"4\"><legend id='gfield_label_21_59' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Krankenhausaufenthalt?<\/span><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_59'>\n\t\t\t<div class='gchoice gchoice_21_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Ja'  id='choice_21_59_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_21_59_0 gfield_label_21_59\"   \/>\n\t\t\t\t\t<label for='choice_21_59_0' id='label_21_59_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Nein'  id='choice_21_59_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_21_59_1' id='label_21_59_1' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_60\" 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\" data-group-id=\"70bb9312\" data-field-span=\"4\"><label id='gfield_label_21_60' class='gfield_label gform-field-label' for='input_21_60'><span class='gform-field-label__text'>Welches Krankenhaus?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_21_60' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_65\" 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 gfield--choice-align-vertical\" data-group-id=\"9234bc14\" data-field-span=\"6\"><legend id='gfield_label_21_65' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?<\/span><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_65'>\n\t\t\t<div class='gchoice gchoice_21_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Ja'  id='choice_21_65_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_21_65_0 gfield_label_21_65\"   \/>\n\t\t\t\t\t<label for='choice_21_65_0' id='label_21_65_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Nein'  id='choice_21_65_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_21_65_1' id='label_21_65_1' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_66\" 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 gfield--choice-align-vertical\" data-group-id=\"9234bc14\" data-field-span=\"6\"><legend id='gfield_label_21_66' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Ist der Verletzte gesetzlich rentenversichert?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_66'>\n\t\t\t<div class='gchoice gchoice_21_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Ja'  id='choice_21_66_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_21_66_0 gfield_label_21_66\"   \/>\n\t\t\t\t\t<label for='choice_21_66_0' id='label_21_66_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Nein'  id='choice_21_66_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_21_66_1' id='label_21_66_1' class='gform-field-label gform-field-label--type-inline'>Nein<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_78\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"59f3962e\" data-field-span=\"12\"><legend id='gfield_label_21_78' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Einwilligung<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_78.1' id='input_21_78_1' type='checkbox' value='1'   aria-labelledby=\"input_21_78_1_label gfield_label_21_78\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label id='input_21_78_1_label' class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_78_1' ><span class='gform-field-label__text'>Ich stimme der Datenschutzerkl\u00e4rung zu.<\/span><\/label><input type='hidden' name='input_78.2' value='Ich stimme der Datenschutzerkl\u00e4rung zu.' class='gform_hidden' \/><input type='hidden' name='input_78.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_21' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >ABSENDEN<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_21' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_21' id='gform_theme_21' value='gravity-theme' \/>\n            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\/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_21' id='gform_target_page_number_21' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_21' id='gform_source_page_number_21' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_21' value='' \/>\n        <\/div>\n                        <input type=\"hidden\" id=\"ct_checkjs_e744f91c29ec99f0e662c9177946c627\" name=\"ct_checkjs\" value=\"0\" \/><script>setTimeout(function(){var ct_input_name = \"ct_checkjs_e744f91c29ec99f0e662c9177946c627\";if (document.getElementById(ct_input_name) !== null) {var ct_input_value = document.getElementById(ct_input_name).value;document.getElementById(ct_input_name).value = document.getElementById(ct_input_name).value.replace(ct_input_value, '63e94b69225451aa4411bcc49c4210af095bd89ae3deb444968bea89264ea14b');}}, 1000);<\/script><input\n                    class=\"apbct_special_field apbct_email_id__gravity_form\"\n                    name=\"apbct__email_id__gravity_form\"\n                    aria-label=\"apbct__label_id__gravity_form\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><input\n                    class=\"apbct_special_field apbct_email_id__elementor_form\"\n                    name=\"apbct__email_id__elementor_form\"\n                    aria-label=\"apbct__label_id__elementor_form\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><\/form>\n                        <\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3866268 elementor-widget elementor-widget-spacer\" data-id=\"3866268\" data-element_type=\"widget\" data-e-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\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-605b775 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 wpr-column-slider-no wpr-equal-height-no\" data-id=\"605b775\" data-element_type=\"section\" data-e-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-83db8f7\" data-id=\"83db8f7\" data-element_type=\"column\" data-e-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-76a0029 elementor-widget elementor-widget-menu-anchor\" data-id=\"76a0029\" data-element_type=\"widget\" data-e-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-af8200b elementor-widget elementor-widget-heading\" data-id=\"af8200b\" data-element_type=\"widget\" data-e-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\">Fragebogen f\u00fcr Anspruchsteller als Download<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0f284ba elementor-widget elementor-widget-text-editor\" data-id=\"0f284ba\" data-element_type=\"widget\" data-e-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>Solltest du dich f\u00fcr die schriftliche M\u00f6glichkeit entscheiden sende uns diesen &#8211; bevorzugt per E-Mail &#8211; an\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-04954d3 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"04954d3\" data-element_type=\"widget\" data-e-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-17c68e0 elementor-widget elementor-widget-button\" data-id=\"17c68e0\" data-element_type=\"widget\" data-e-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-vb.pdf\" target=\"_blank\">\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\">ZUM FRAGEBOGEN ALS 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-5710265 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"5710265\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6272df1 elementor-widget elementor-widget-spacer\" data-id=\"6272df1\" data-element_type=\"widget\" data-e-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-a1a36cc elementor-widget elementor-widget-menu-anchor\" data-id=\"a1a36cc\" data-element_type=\"widget\" data-e-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-ba14c25 elementor-widget elementor-widget-heading\" data-id=\"ba14c25\" data-element_type=\"widget\" data-e-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\">Dein Kontakt zu uns!<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4215ea3 elementor-widget elementor-widget-text-editor\" data-id=\"4215ea3\" data-element_type=\"widget\" data-e-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>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<\/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-59ea3a2 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"59ea3a2\" data-element_type=\"widget\" data-e-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:051414870878\">\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 48708-78<\/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 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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\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>ROZSTRZYGANIE ROSZCZE\u0143 W PRZYPADKU WYPADK\u00d3W Mia\u0142e\u015b wypadek z udzia\u0142em jednego z naszych pojazd\u00f3w? Nie ma problemu, ch\u0119tnie Ci pomo\u017cemy. Je\u015bli mia\u0142e\u015b wypadek z udzia\u0142em jednego z naszych pojazd\u00f3w, prosimy o skontaktowanie si\u0119 z nami przed podj\u0119ciem dalszych krok\u00f3w. Kwestionariusz dla wnioskodawc\u00f3w mo\u017cna wype\u0142ni\u0107 online lub pobra\u0107 w formacie PDF. Prosimy o do\u0142\u0105czenie do pisma wszystkich istotnych informacji i dokument\u00f3w dotycz\u0105cych wypadku (np. zdj\u0119\u0107, zezna\u0144 \u015bwiadk\u00f3w, protoko\u0142u policyjnego), aby\u015bmy mogli szybko rozpatrzy\u0107 Twoj\u0105 spraw\u0119. Kwestionariusz dla os\u00f3b zg\u0142aszaj\u0105cych roszczenie \u201e*\u201c oznacza pola obowi\u0105zkowe Dane osobowe Tytu\u0142*PanPaniBrak danych Nazwisko* Imi\u0119 Nazwisko Telefon*E-mail* Adres* Adres Miasto Kod pocztowy AfganistanEgiptWyspy AlandzkieAlbaniaAlgieriaAmeryka\u0144skie- Samoa, Ameryka\u0144skie Wyspy Dziewicze, Andora, Angola, Anguilla, Antarktyda, Antigua i Barbuda, Gwinea R\u00f3wnikowa, Argentyna, Armenia, Aruba, Azerbejd\u017can, Etiopia, Australia, Bahamy, Bahrajn, Bangladesz, Barbados, Belgia, Belize, Benin, Bermudy, Bhutan, BoliwBosnia i Hercegowina, Botswana, Wyspa Bouveta, Brazylia, Brytyjskie Wyspy Dziewicze, Brytyjskie Terytorium na Oceanie Indyjskim, Brunei Darussalam, Bu\u0142garia, Burkina Faso, Burundi, Kajmany, Chile, Chiny, Wyspy Cooka, Kostaryka, Wybrze\u017ce Ko\u015bci S\u0142oniowej,Ko\u015bci S\u0142oniowej, Cura\u00e7ao, Dania, Laota\u0144ska Republika Ludowo-Demokratyczna, Niemcy, D\u017cibuti, Dominika, Republika Dominika\u0144ska, Ekwador, Salwador, Erytrea, Estonia, Eswatini, Falklandy, Wyspy OwczeFid\u017ci, Finlandia, Francja, Gujana Francuska, Polinezja Francuska, Francuskie Terytoria Po\u0142udniowe i Antarktyczne, Futuna (Wallis i Futuna)GabonGambiaGruzjaGhanaGibraltarGrenadaGrecjaGrenlandiaWielka BrytaniaGwadelupaGuamGwatemalaGuernseyGwineaGwinea-Bissau, Gujana, Haiti, Wyspy Hearda i McDonalda, Stolica Apostolska, Honduras, Hongkong, Indie, Indonezja, Irak, Iran, Irlandia, Islandia, Wyspa Man, Izrael, W\u0142ochy, Jamajka, Japonia, Jemen, Jersey, Jordania, Kambod\u017ca, Kamerun, Kanada, Wyspy Zielonego Przyl\u0105dka, Karaibska cz\u0119\u015b\u0107 Holandii, Kazachstan Katar Kenia Kirgistan Kiribati Wyspy Kokosowe Kolumbia Komory Kongo Kongo, Demokratyczna Republika Korei. Chropowata Republika Ludowa Chorwacja Kuba Kuwejt Lesotho \u0141otwa Liban Liberia Libia Liechtenstein Litwa Luksemburg Makau Madagaskar Malawi Malezja Malediwy Mali Malta MarokoWyspy Martynika Mauretania Mauritius Majotta Meksyk Mikronezja Mo\u0142dawia Monako Mongolia Czarnog\u00f3ra Montserrat Mozambik Mjanma Namibia Nauru Nepal Nowa Kaledonia Nowa Zelandia Nikaragua Holandia Niger Nigeria Niue MarianP\u00f3\u0142nocna Macedonia Wyspa Norfolka Norwegia Oman Austria Timor Wschodni Pakistan Palestyna, Pa\u0144stwo Palau Panama Papua-Nowa Gwinea Paragwaj Peru Filipiny Wyspy Pitcairn Polska Portugalia Portoryko R\u00e9union Rwandy Rumunia Federacja Rosyjska Saint-Barth\u00e9lemy, Saint-Pierre i Miquelon, Wyspy Salomona, Zambia, Samoa, San Marino, Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca, Arabia Saudyjska, Szwecja, Szwajcaria, Senegal, Serbia, Seszele, Sierra Leone, Zimbabwe, Singapur, Sint Maarten, S\u0142owenia, S\u0142owacja, Somalia, Hiszpania, Sri Lanka, Wyspa \u015bw. Heleny, Ascension i Tristan da Cunha, Saint Kitts i Nevis, Saint Lucia, Saint Martin, Saint Vincent i Grenadyny, Republika Po\u0142udniowej Afryki, Sudan, Georgia Po\u0142udniowa i Wyspy Sandwich Po\u0142udniowe, Korea Po\u0142udniowa, Sudan Po\u0142udniowy, Surinam, Svalbard i Jan Mayen, Syria, Republika Arabska Tad\u017cykistan Tajwan Tanzania, Zjednoczona Republika Tajlandia Togo Tokelau Tonga Trynidad i Tobago Czad Czechy Tunezja Turcja Turkmenistani CaicosTuvaluUgandaUkrainaW\u0119gryUrugwajMniejsze Odleg\u0142e Wyspy Stan\u00f3w ZjednoczonychUzbekistanVanuatuWenezuelaZjednoczone Emiraty ArabskieStany Zjednoczone AmerykiWietnamWyspa Bo\u017cego NarodzeniaBia\u0142oru\u015bSahara ZachodniaRepublika \u015arodkowoafryka\u0144skaCypr Dane dotycz\u0105ce miejsca wypadku* Data* Dzie\u0144Dzie\u014412345678910111213141516171819202122232425262728293031Miesi\u0105cMiesi\u0105c123456789101112RrokRok202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Czas* godziny : Minuty Ulica\/skrzy\u017cowanie* Linia\/numer kursu* Przystanek Numer rejestracyjny autobusu Imi\u0119 i nazwisko kierowcy Opis wypadku* Plik Przeci\u0105gnij pliki tutaj lub wybierz pliki Maks. rozmiar pliku: 32 MB. \u015awiadkowie Czy s\u0105 \u015bwiadkowie?* Tak Nie Nazwisko* Imi\u0119 Nazwisko Adres* Adres Miasto Kod pocztowy Telefon Czy s\u0105 inni \u015bwiadkowie?* Tak Nie Nazwisko* Imi\u0119 Nazwisko Adres* Adres Miasto Kod pocztowy Telefon* Protok\u00f3\u0142 policyjny Komenda Numer sprawy Adres Adres Miasto Kod pocztowy Plik Maks. rozmiar pliku: 32 MB. Szkody materialne Czy dosz\u0142o do uszkodzenia mienia?* Tak Nie Co uleg\u0142o uszkodzeniu?* W\u0142a\u015bciciel (ewentualnie leasingodawca)* Imi\u0119 Nazwisko Uprawniony do odliczenia podatku naliczonego?* Tak Nie Uszkodzenia pojazd\u00f3w silnikowych \u2013 samochody osobowe, ci\u0119\u017car\u00f3wki itp. (je\u015bli dotyczy) Czy dosz\u0142o do uszkodzenia pojazdu silnikowego?* Tak Nie Rodzaj*Samoch\u00f3d osobowy (auto)Pojazdy u\u017cytkowe (ci\u0119\u017car\u00f3wka)Pojazdy dwuko\u0142owe (skuter, motocykl)Maszyny rolnicze\/budowlaneKamper\/przyczepa kempingowaProducent*TypOficjalny numer rejestracyjny*Ubezpieczenie* Szkody osobowe Czy dosz\u0142o do szk\u00f3d osobowych?* Tak Nie Tytu\u0142*PanPaniBrak danych Imi\u0119 i nazwisko* Imi\u0119 Nazwisko Adres* Adres Miasto Kod pocztowy AfganistanEgiptWyspy AlandzkieAlbaniaAlgieriaSamoa Ameryka\u0144skieSamoa, Ameryka\u0144skie Wyspy Dziewicze, Andora, Angola, Anguilla, Antarktyda, Antigua i Barbuda, Gwinea R\u00f3wnikowa, Argentyna, Armenia, Aruba, Azerbejd\u017can, Etiopia, Australia, Bahamy, Bahrajn, Bangladesz, Barbados, Belgia, Belize, Benin, Bermudy, Bhutan, BoliwBosnia i Hercegowina, Botswana, Wyspa Bouveta, Brazylia, Brytyjskie Wyspy Dziewicze, Brytyjskie Terytorium na Oceanie Indyjskim, Brunei Darussalam, Bu\u0142garia, Burkina Faso, Burundi, Wyspy Kajma\u0144skie, Chile, Chiny, Wyspy Cooka, Kostaryka, Wybrze\u017ce Ko\u015bci S\u0142oniowej, Cura\u00e7ao, Dania, Laota\u0144ska Republika Ludowo-Demokratyczna, Niemcy, D\u017cibuti, Dominika, Dominikana, Ekwador, Salwador, Erytrea, Estonia, Eswatini, Wyspy Falklandzkie, Wyspy Owcze,Ko\u015bci S\u0142oniowej, Cura\u00e7ao, Dania, Laota\u0144ska Republika Ludowo-Demokratyczna, Niemcy, D\u017cibuti, Dominika, Republika Dominikany, Ekwador, Salwador, Erytrea, Estonia, Eswatini, Falklandy, Wyspy OwczeFid\u017ci, Finlandia, Francja, Gujana Francuska, Polinezja Francuska, Francuskie Terytoria Po\u0142udniowe i Antarktyczne, Futuna (Wallis i Futuna)GabonGambiaGruzjaGhanaGibraltarGrenadaGrecjaGroenlandiaWielka BrytaniaGuadelupaGuamGwatemalaGuernseyGwineaGwinea-BissauGujanaHaitiWyspy Heard i McDonaldStolica ApostolskaHondurasHongkongIndieIndonezjaIrakIranIrlandiaIslandiaWyspa ManIzraelW\u0142ochyJamajkaJaponiaJemenJerseyJordaniaKambod\u017caKamerunKanadaWyspy Zielonego Przyl\u0105dkaKaraiby NiderlandzkieKazachstan Katar Kenia Kirgistan Kiribati Wyspy Kokosowe Kolumbia Komory Kongo Kongo, Demokratyczna Republika Korei. ChropacjaKubaKuwejtLesotho\u0141otwaLibanLiberiaLibiaLiechtensteinLitwaLuksemburgMakauMadagaskarMalawiMalezjaMalediwyMaliMaltaMarokoWyspy MarshallaWyspy Martynika Mauretania Mauritius Majotta Meksyk Mikronezja Mo\u0142dawia Monako Mongolia Czarnog\u00f3ra Montserrat Mozambik Mjanma Namibia Nauru Nepal Nowa Kaledonia Nowa Zelandia Nikaragua Holandia Niger Nigeria Niue P\u00f3\u0142nocne Wyspy MarianP\u00f3\u0142nocna Makedonia Wyspa Norfolka Norwegia Oman Austria Timor Wschodni Pakistan Palestyna, pa\u0144stwo Palau Panama Papua-Nowa Gwinea Paragwaj Peru Filipiny Wyspy Pitcairn Polska Portugalia Portoryko Reunion Ruanda Rumunia Federacja Rosyjska Saint-Barth\u00e9lemy, Saint-Pierre i Miquelon, Wyspy Salomona, Zambia, Samoa, San Marino, Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca, Arabia Saudyjska, Szwecja, Szwajcaria, Senegal, Serbia, Seszele, Sierra Leone, Zimbabwe, Singapur, Sint Maarten, S\u0142owenia, S\u0142owacja, Somalia, Hiszpania, Sri Lanka, Wyspa \u015bw. Heleny, Ascension i Tristan da Cunha, Saint Kitts i Nevis, Saint Lucia, Saint Martin, Saint Vincent i Grenadyny, Republika Po\u0142udniowej Afryki, Sudan, Georgia Po\u0142udniowa i Wyspy Sandwich Po\u0142udniowe, Korea Po\u0142udniowa, Sudan Po\u0142udniowy, Surinam, Svalbard i Jan Mayen, Syria, Republika Arabska Tad\u017cykistan Tajwan Tanzania, Zjednoczona Republika Tajlandia Togo Tokelau Tonga Trynidad i Tobago Czad Czechy Tunezja Turcja Turkmenistani CaicosTuvaluUgandaUkrainaW\u0119gryUrugwajMniejsze Odleg\u0142e Wyspy Stan\u00f3w ZjednoczonychUzbekistanVanuatuWenezuelaZjednoczone Emiraty ArabskieStany Zjednoczone AmerykiWietnamWyspa Bo\u017cego NarodzeniaBia\u0142oru\u015bSahara ZachodniaRepublika \u015arodkowoafryka\u0144skaCypr Kraj Numer telefonu*E-mail Rodzaj i zakres obra\u017ce\u0144* Czy zapinano pasy bezpiecze\u0144stwa? Tak Nie Pobyt w szpitalu?* Tak Nie W kt\u00f3rym szpitalu? Czy wypadek mia\u0142 miejsce w drodze do lub z pracy?* Tak Nie Czy poszkodowany jest obj\u0119ty ustawowym ubezpieczeniem emerytalnym? Tak Nie Czy inne osoby odnios\u0142y obra\u017cenia?* Tak Nie Tytu\u0142*PanPaniBrak danych Imi\u0119* Imi\u0119 Nazwisko Adres* Adres Miasto Kod pocztowy AfganistanEgiptWyspy AlandzkieAlbaniaAlgieriaAmeryka\u0144skie-Samoa, Ameryka\u0144skie Wyspy Dziewicze, Andora, Angola, Anguilla, Antarktyda, Antigua i Barbuda, Gwinea R\u00f3wnikowa, Argentyna, Armenia, Aruba, Azerbejd\u017can, Etiopia, Australia, Bahamy, Bahrajn, Bangladesz, Barbados, Belgia, Belize, Benin, Bermudy, Bhutan, BoliwBosnia i Hercegowina, Botswana, Wyspa Bouveta, Brazylia, Brytyjskie Wyspy Dziewicze, Brytyjskie Terytorium na Oceanie Indyjskim, Brunei Darussalam, Bu\u0142garia, Burkina Faso, Burundi, Kajmany, Chile, Chiny, Wyspy Cooka, Kostaryka, Wybrze\u017ce Ko\u015bci S\u0142oniowej,Ko\u015bci S\u0142oniowej, Cura\u00e7ao, Dania, Laota\u0144ska Republika Ludowo-Demokratyczna, Niemcy, D\u017cibuti, Dominika, Republika Dominikany, Ekwador, Salwador, Erytrea, Estonia, Eswatini, Falklandy, Wyspy OwczeFid\u017ci, Finlandia, Francja, Gujana Francuska, Polinezja Francuska, Francuskie Terytoria Po\u0142udniowe i Antarktyczne, Futuna (Wallis i Futuna)GabonGambiaGruzjaGhanaGibraltarGrenadaGrecjaGroenlandiaWielka BrytaniaGwadelupaGuamGwatemalaGuernseyGwineaGwinea-Bissau, Gujana, Haiti, Wyspy Heard i McDonald, Stolica Apostolska, Honduras, Hongkong, Indie, Indonezja, Irak, Iran, Irlandia, Islandia, Wyspa Man, Izrael, W\u0142ochy, Jamajka, Japonia, Jemen, Jersey, Jordania, Kambod\u017ca, Kamerun, Kanada, Wyspy Zielonego Przyl\u0105dka, Karaiby Niderlandzkie, Kazachstan Katar Kenia Kirgistan Kiribati Wyspy Kokosowe Kolumbia Komory Kongo Kongo, Demokratyczna Republika Korei. ChropacjaKubaKuwejtLesotho\u0141otwaLibanLiberiaLibiaLiechtensteinLitwaLuksemburgMakauMadagaskarMalawiMalezjaMalediwyMaliMaltaMarokoWyspy Martynika Mauretania Mauritius Majotta Meksyk Mikronezja Mo\u0142dawia Monako Mongolia Czarnog\u00f3ra Montserrat Mozambik Mjanma Namibia Nauru Nepal Nowa Kaledonia Nowa Zelandia Nikaragua Holandia Niger Nigeria Niue P\u00f3\u0142nocne Wyspy MarianP\u00f3\u0142nocna Makedonia Wyspa Norfolka Norwegia Oman Austria Timor Wschodni Pakistan Palestyna, pa\u0144stwo Palau Panama Papua-Nowa Gwinea Paragwaj Peru Filipiny Wyspy Pitcairn Polska Portugalia Portoryko Reunion Ruanda Rumunia Federacja Rosyjska Saint-Barth\u00e9lemy, Saint-Pierre i Miquelon, Wyspy Salomona, Zambia, Samoa, San Marino, Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca, Arabia Saudyjska, Szwecja, Szwajcaria, Senegal, Serbia, Seszele, Sierra Leone, Zimbabwe, Singapur, Sint Maarten, S\u0142owenia, S\u0142owacja, Somalia, Hiszpania, Sri Lanka, Wyspa \u015awi\u0119tej Heleny, Ascension i Tristan da Cunha, Saint Kitts i Nevis, Saint Lucia, Saint Martin, Saint Vincent i Grenadyny, RPA, Sudan, Georgia Po\u0142udniowa i Wyspy Sandwich Po\u0142udniowe, Korea Po\u0142udniowa, Sudan Po\u0142udniowy, Surinam, Svalbard i Jan Mayen, Syria, Republika Arabska, Tad\u017cykistan, Tajwan, Tanzania, Zjednoczona Republika, Tajlandia, Togo, Tokelau, Tonga, Trynidad i Tobago, Czad, Czechy, Tunezja, Turcja, Turkmenistan,i CaicosTuvaluUgandaUkrainaW\u0119gryUrugwajMniejsze Odleg\u0142e Wyspy Stan\u00f3w ZjednoczonychUzbekistanVanuatuWenezuelaZjednoczone Emiraty ArabskieStany Zjednoczone AmerykiWietnamWyspa Bo\u017cego NarodzeniaBia\u0142oru\u015bSahara ZachodniaRepublika \u015arodkowoafryka\u0144skaCypr Kraj Numer telefonu*E-mail Rodzaj i zakres obra\u017ce\u0144* Czy zapinano pas bezpiecze\u0144stwa? Tak Nie Pobyt w szpitalu?* Tak Nie W kt\u00f3rym szpitalu? Czy wypadek mia\u0142 miejsce w drodze do lub z pracy?* Tak Nie Czy poszkodowany jest obj\u0119ty ustawowym ubezpieczeniem emerytalnym? Tak Nie Zgoda* Wyra\u017cam zgod\u0119 na polityk\u0119 prywatno\u015bci. WY\u015aLIJ Kwestionariusz dla os\u00f3b ubiegaj\u0105cych si\u0119 o odszkodowanie do pobrania Je\u015bli zdecydujesz si\u0119 na zg\u0142oszenie pisemne, prze\u015blij nam ten kwestionariusz \u2013 najlepiej poczt\u0105 elektroniczn\u0105 \u2013 na adres versicherung@kvg-bus.de Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle DO KWESTIONARIUSZA W FORMACIE PDF Skontaktuj si\u0119 z nami! Masz pytania lub chcesz nam co\u015b przekaza\u0107? Jeste\u015bmy do Twojej dyspozycji w czwartki w godz. 8:00\u201316:00 oraz w pi\u0105tki w godz. 8:00\u201312:00.\u00a0 05141 48708-78 versicherung@kvg-bus.de Jak bardzo podoba Ci si\u0119 nasza strona internetowa? Znakomicie Przewa\u017cnie dobrze Neutralnie Nie za dobrze Okropnie Na kt\u00f3rej stronie si\u0119 znajdujesz? (wymagane) Czy chcesz nam jeszcze co\u015b przekaza\u0107? WY\u015aLIJ<\/p>","protected":false},"author":4,"featured_media":4083,"parent":16,"menu_order":18,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3246","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Schadenabwicklung - VB-Hornburg<\/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:\/\/vb-bachstein.de\/hornburg\/usluga\/dla-firm-2\/\" \/>\n<meta property=\"og:locale\" content=\"pl_PL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Schadenabwicklung - VB-Hornburg\" \/>\n<meta property=\"og:description\" content=\"SCHADENSABWICKLUNG BEI UNF\u00c4LLEN Du hattest einen Unfall mit einem unserer Fahrzeuge? Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit einem unserer Fahrzeuge hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du online ausf\u00fcllen oder als PDF herunterladen. Bitte f\u00fcge 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 Anspruchsteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ Afghanistan\u00c4gypten\u00c5landinselnAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und Barbuda\u00c4quatorial GuineaArgentinienArmenienArubaAserbaidschan\u00c4thopienAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaC\u00f4te d&#039;IvoireCura\u00e7aoD\u00e4nemarkDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnF\u00e4r\u00f6er-InselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)GabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGr\u00f6nlandGro\u00dfbritannienGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueN\u00f6rdliche MarianenNordmazedonienNorfolkinselNorwegenOman\u00d6sterreichOsttimorPakistanPal\u00e4stina, BundesstaatPalauPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoR\u00e9unionRuandaRum\u00e4nienRussische F\u00f6derationSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoS\u00e3o Tom\u00e9 und Pr\u00edncipeSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenS\u00fcdafrikaSudanS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienT\u00fcrkeiTurkmenistanTurks- und CaicosinselnTuvaluUgandaUkraineUngarnUruguayUS Minor Outlying IslandsUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern Land Angaben zum Unfall Ort* Datum* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 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 Afghanistan\u00c4gypten\u00c5landinselnAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und Barbuda\u00c4quatorial GuineaArgentinienArmenienArubaAserbaidschan\u00c4thopienAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaC\u00f4te d&#039;IvoireCura\u00e7aoD\u00e4nemarkDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnF\u00e4r\u00f6er-InselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)GabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGr\u00f6nlandGro\u00dfbritannienGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueN\u00f6rdliche MarianenNordmazedonienNorfolkinselNorwegenOman\u00d6sterreichOsttimorPakistanPal\u00e4stina, BundesstaatPalauPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoR\u00e9unionRuandaRum\u00e4nienRussische F\u00f6derationSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoS\u00e3o Tom\u00e9 und Pr\u00edncipeSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenS\u00fcdafrikaSudanS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienT\u00fcrkeiTurkmenistanTurks- und CaicosinselnTuvaluUgandaUkraineUngarnUruguayUS Minor Outlying IslandsUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern 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 Afghanistan\u00c4gypten\u00c5landinselnAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und Barbuda\u00c4quatorial GuineaArgentinienArmenienArubaAserbaidschan\u00c4thopienAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaC\u00f4te d&#039;IvoireCura\u00e7aoD\u00e4nemarkDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnF\u00e4r\u00f6er-InselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)GabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGr\u00f6nlandGro\u00dfbritannienGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueN\u00f6rdliche MarianenNordmazedonienNorfolkinselNorwegenOman\u00d6sterreichOsttimorPakistanPal\u00e4stina, BundesstaatPalauPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoR\u00e9unionRuandaRum\u00e4nienRussische F\u00f6derationSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoS\u00e3o Tom\u00e9 und Pr\u00edncipeSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenS\u00fcdafrikaSudanS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienT\u00fcrkeiTurkmenistanTurks- und CaicosinselnTuvaluUgandaUkraineUngarnUruguayUS Minor Outlying IslandsUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern 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 Einwilligung* Ich stimme der Datenschutzerkl\u00e4rung zu. ABSENDEN Fragebogen f\u00fcr Anspruchsteller als Download Solltest du dich f\u00fcr die schriftliche M\u00f6glichkeit entscheiden 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 48708-78 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? ABSENDEN\" \/>\n<meta property=\"og:url\" content=\"https:\/\/vb-bachstein.de\/hornburg\/usluga\/dla-firm-2\/\" \/>\n<meta property=\"og:site_name\" content=\"VB-Hornburg\" \/>\n<meta property=\"article:modified_time\" content=\"2026-09-03T13:07:18+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Szacowany czas czytania\" \/>\n\t<meta name=\"twitter:data1\" content=\"10 minut\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/fuer-unternehmen\\\/\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/fuer-unternehmen\\\/\",\"name\":\"Schadenabwicklung - VB-Hornburg\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/fuer-unternehmen\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/fuer-unternehmen\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/header-subsites_vb-2.jpg\",\"datePublished\":\"2025-10-14T13:36:11+00:00\",\"dateModified\":\"2026-09-03T13:07:18+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/fuer-unternehmen\\\/#breadcrumb\"},\"inLanguage\":\"pl-PL\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/fuer-unternehmen\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"pl-PL\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/fuer-unternehmen\\\/#primaryimage\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/header-subsites_vb-2.jpg\",\"contentUrl\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/header-subsites_vb-2.jpg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/fuer-unternehmen\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Startseite\",\"item\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Service\",\"item\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/service\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Schadenabwicklung\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/#website\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/\",\"name\":\"VB-Hornburg\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"pl-PL\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/#organization\",\"name\":\"VB-Hornburg\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pl-PL\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/vb-bachstein_logo.svg\",\"contentUrl\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/vb-bachstein_logo.svg\",\"caption\":\"VB-Hornburg\"},\"image\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/hornburg\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Rozliczanie roszcze\u0144 - VB-Hornburg","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:\/\/vb-bachstein.de\/hornburg\/usluga\/dla-firm-2\/","og_locale":"pl_PL","og_type":"article","og_title":"Schadenabwicklung - VB-Hornburg","og_description":"SCHADENSABWICKLUNG BEI UNF\u00c4LLEN Du hattest einen Unfall mit einem unserer Fahrzeuge? Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit einem unserer Fahrzeuge hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du online ausf\u00fcllen oder als PDF herunterladen. Bitte f\u00fcge 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 Anspruchsteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ Afghanistan\u00c4gypten\u00c5landinselnAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und Barbuda\u00c4quatorial GuineaArgentinienArmenienArubaAserbaidschan\u00c4thopienAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaC\u00f4te d&#039;IvoireCura\u00e7aoD\u00e4nemarkDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnF\u00e4r\u00f6er-InselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)GabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGr\u00f6nlandGro\u00dfbritannienGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueN\u00f6rdliche MarianenNordmazedonienNorfolkinselNorwegenOman\u00d6sterreichOsttimorPakistanPal\u00e4stina, BundesstaatPalauPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoR\u00e9unionRuandaRum\u00e4nienRussische F\u00f6derationSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoS\u00e3o Tom\u00e9 und Pr\u00edncipeSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenS\u00fcdafrikaSudanS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienT\u00fcrkeiTurkmenistanTurks- und CaicosinselnTuvaluUgandaUkraineUngarnUruguayUS Minor Outlying IslandsUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern Land Angaben zum Unfall Ort* Datum* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 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 Afghanistan\u00c4gypten\u00c5landinselnAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und Barbuda\u00c4quatorial GuineaArgentinienArmenienArubaAserbaidschan\u00c4thopienAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaC\u00f4te d&#039;IvoireCura\u00e7aoD\u00e4nemarkDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnF\u00e4r\u00f6er-InselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)GabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGr\u00f6nlandGro\u00dfbritannienGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueN\u00f6rdliche MarianenNordmazedonienNorfolkinselNorwegenOman\u00d6sterreichOsttimorPakistanPal\u00e4stina, BundesstaatPalauPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoR\u00e9unionRuandaRum\u00e4nienRussische F\u00f6derationSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoS\u00e3o Tom\u00e9 und Pr\u00edncipeSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenS\u00fcdafrikaSudanS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienT\u00fcrkeiTurkmenistanTurks- und CaicosinselnTuvaluUgandaUkraineUngarnUruguayUS Minor Outlying IslandsUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern 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 Afghanistan\u00c4gypten\u00c5landinselnAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und Barbuda\u00c4quatorial GuineaArgentinienArmenienArubaAserbaidschan\u00c4thopienAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaC\u00f4te d&#039;IvoireCura\u00e7aoD\u00e4nemarkDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnF\u00e4r\u00f6er-InselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)GabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGr\u00f6nlandGro\u00dfbritannienGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. 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