{"id":3375,"date":"2025-11-05T09:50:29","date_gmt":"2025-11-05T08:50:29","guid":{"rendered":"https:\/\/vb-bachstein.de\/wolfsburg\/?page_id=3375"},"modified":"2026-01-19T14:17:07","modified_gmt":"2026-01-19T13:17:07","slug":"liquidacion-de-siniestros","status":"publish","type":"page","link":"https:\/\/vb-bachstein.de\/wolfsburg\/es\/service\/schadenabwicklung\/","title":{"rendered":"gesti\u00f3n de siniestros"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3375\" class=\"elementor elementor-3375\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-094f012 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-equal-height-no\" data-id=\"094f012\" 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-d575672\" data-id=\"d575672\" 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-651d6d6 elementor-widget elementor-widget-heading\" data-id=\"651d6d6\" 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\">SCHADENABWICKLUNG 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-0beba67 elementor-widget elementor-widget-text-editor\" data-id=\"0beba67\" 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 Fahrzeugen? 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-f44c9d8 elementor-hidden-mobile\" data-id=\"f44c9d8\" 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-ba132d1 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-equal-height-no e-con e-parent\" data-id=\"ba132d1\" 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-5fbb0b5 elementor-widget elementor-widget-text-editor\" data-id=\"5fbb0b5\" 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 den Verkehrsbetrieben Bachstein 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\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen.<\/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-5574ee0 elementor-widget elementor-widget-spacer\" data-id=\"5574ee0\" 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-556b84f e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-equal-height-no e-con e-parent\" data-id=\"556b84f\" 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-13a4dfe elementor-widget elementor-widget-menu-anchor\" data-id=\"13a4dfe\" 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-3b6dbe0 elementor-widget elementor-widget-heading\" data-id=\"3b6dbe0\" 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 Anspruchssteller <\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e3ee1d elementor-widget elementor-widget-elementor-extension-gravity-forms\" data-id=\"2e3ee1d\" data-element_type=\"widget\" data-e-type=\"widget\" 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gfield_required_asterisk\">*<\/span>&quot; se\u00f1ala los campos obligatorios<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_21'  action='\/wolfsburg\/es\/wp-json\/wp\/v2\/pages\/3375' 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'><div id=\"field_21_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">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\"  ><label class='gfield_label gform-field-label' for='input_21_3'>Anrede<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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_5'>\n                            \n                            <span id='input_21_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_21_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_5_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_21_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_5_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_21_12\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_12'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_12' id='input_21_12' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_13\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_13'>E-Mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_13' id='input_21_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_21_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_21_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_21_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_6_1' id='input_21_6_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/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 '>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_6.4' id='input_21_6_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_21_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_6_5' id='input_21_6_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ C\u00f3digo Postal<\/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='Afghanist\u00e1n' >Afghanist\u00e1n<\/option><option value='Albania' >Albania<\/option><option value='Alemania' >Alemania<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antigua y Barbuda' >Antigua y Barbuda<\/option><option value='Ant\u00e1rtida' >Ant\u00e1rtida<\/option><option value='Arabia Saudita' >Arabia Saudita<\/option><option value='Argelia' >Argelia<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaiy\u00e1n' >Azerbaiy\u00e1n<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Bar\u00e9in' >Bar\u00e9in<\/option><option value='Belice' >Belice<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhut\u00e1n' >Bhut\u00e1n<\/option><option value='Bielorusia' >Bielorusia<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, San Eustaquio y Saba' >Bonaire, San Eustaquio y Saba<\/option><option value='Bosnia y Herzegovina' >Bosnia y Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brasil' >Brasil<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9lgica' >B\u00e9lgica<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Camboya' >Camboya<\/option><option value='Camer\u00fan' >Camer\u00fan<\/option><option value='Canada' >Canada<\/option><option value='Chad' >Chad<\/option><option value='Chequia' >Chequia<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Chipre' >Chipre<\/option><option value='Colombia' >Colombia<\/option><option value='Comoras' >Comoras<\/option><option value='Congo' >Congo<\/option><option value='Congo, Rep\u00fablica Democr\u00e1tica del' >Congo, Rep\u00fablica Democr\u00e1tica del<\/option><option value='Corea, Rep\u00fablica Popular Democr\u00e1tica de' >Corea, Rep\u00fablica Popular Democr\u00e1tica de<\/option><option value='Corea, Rep\u00fablica de' >Corea, Rep\u00fablica de<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Costa de Marfil' >Costa de Marfil<\/option><option value='Croacia' >Croacia<\/option><option value='Cuba' >Cuba<\/option><option value='Curazao' >Curazao<\/option><option value='Dinamarca' >Dinamarca<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egipto' >Egipto<\/option><option value='El Salvador' >El Salvador<\/option><option value='Emiratos \u00c1rabes Unidos' >Emiratos \u00c1rabes Unidos<\/option><option value='Eritrea' >Eritrea<\/option><option value='Eslovaquia' >Eslovaquia<\/option><option value='Eslovenia' >Eslovenia<\/option><option value='Espa\u00f1a' >Espa\u00f1a<\/option><option value='Estados Unidos' >Estados Unidos<\/option><option value='Estonia' >Estonia<\/option><option value='Esuatini' >Esuatini<\/option><option value='Etiop\u00eda' >Etiop\u00eda<\/option><option value='Federaci\u00f3n Rusa' >Federaci\u00f3n Rusa<\/option><option value='Fiji' >Fiji<\/option><option value='Filipinas' >Filipinas<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francia' >Francia<\/option><option value='Gab\u00f3n' >Gab\u00f3n<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Granada' >Granada<\/option><option value='Grecia' >Grecia<\/option><option value='Groenlandia' >Groenlandia<\/option><option value='Guadalupe' >Guadalupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guayana' >Guayana<\/option><option value='Guayana Francesa' >Guayana Francesa<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea Bissau' >Guinea Bissau<\/option><option value='Guinea Ecuatorial' >Guinea Ecuatorial<\/option><option value='Hait\u00ed' >Hait\u00ed<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungr\u00eda' >Hungr\u00eda<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iraq' >Iraq<\/option><option value='Irlanda' >Irlanda<\/option><option value='Ir\u00e1n' >Ir\u00e1n<\/option><option value='Isla Bouvet' >Isla Bouvet<\/option><option value='Isla Norfolk' >Isla Norfolk<\/option><option value='Isla de Man' >Isla de Man<\/option><option value='Isla de Navidad' >Isla de Navidad<\/option><option value='Islandia' >Islandia<\/option><option value='Islas Caim\u00e1n' >Islas Caim\u00e1n<\/option><option value='Islas Cocos' >Islas Cocos<\/option><option value='Islas Cook' >Islas Cook<\/option><option value='Islas Faroe' >Islas Faroe<\/option><option value='Islas Heard y McDonald' >Islas Heard y McDonald<\/option><option value='Islas Malvinas' >Islas Malvinas<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Islas Marshall' >Islas Marshall<\/option><option value='Islas Salom\u00f3n' >Islas Salom\u00f3n<\/option><option value='Islas Turcas y Caicos' >Islas Turcas y Caicos<\/option><option value='Islas Ultramarinas Menores de Estados Unidos' >Islas Ultramarinas Menores de Estados Unidos<\/option><option value='Islas V\u00edrgenes Brit\u00e1nicas' >Islas V\u00edrgenes Brit\u00e1nicas<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Islas \u00c5land' >Islas \u00c5land<\/option><option value='Israel' >Israel<\/option><option value='Italia' >Italia<\/option><option value='Jamaica' >Jamaica<\/option><option value='Jap\u00f3n' >Jap\u00f3n<\/option><option value='Jersey' >Jersey<\/option><option value='Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='Jord\u00e1n' >Jord\u00e1n<\/option><option value='Kazajist\u00e1n' >Kazajist\u00e1n<\/option><option value='Kenia' >Kenia<\/option><option value='Kirguist\u00e1n' >Kirguist\u00e1n<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='LIbia' >LIbia<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liberia' >Liberia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituania' >Lituania<\/option><option value='Lituania' >Lituania<\/option><option value='Luxemburgo' >Luxemburgo<\/option><option value='L\u00edbano' >L\u00edbano<\/option><option value='Macau' >Macau<\/option><option value='Macedonia del Norte' >Macedonia del Norte<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malasia' >Malasia<\/option><option value='Malawi' >Malawi<\/option><option value='Maldivas' >Maldivas<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marruecos' >Marruecos<\/option><option value='Martinica' >Martinica<\/option><option value='Mauricio' >Mauricio<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mayotte' >Mayotte<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldavia' >Moldavia<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='M\u00e9xico' >M\u00e9xico<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noruega' >Noruega<\/option><option value='Nueva Caledonia' >Nueva Caledonia<\/option><option value='Nueva Zelanda' >Nueva Zelanda<\/option><option value='N\u00edger' >N\u00edger<\/option><option value='Om\u00e1n' >Om\u00e1n<\/option><option value='Paises Bajos' >Paises Bajos<\/option><option value='Pakist\u00e1n' >Pakist\u00e1n<\/option><option value='Palau' >Palau<\/option><option value='Palestina, Estado de' >Palestina, Estado de<\/option><option value='Panam\u00e1' >Panam\u00e1<\/option><option value='Pap\u00faa Nueva Guinea' >Pap\u00faa Nueva Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Per\u00fa' >Per\u00fa<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinesia Francesa' >Polinesia Francesa<\/option><option value='Polonia' >Polonia<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Reino Unido' >Reino Unido<\/option><option value='Rep\u00fablica Centroafricana' >Rep\u00fablica Centroafricana<\/option><option value='Rep\u00fablica Democr\u00e1tica Popular de Laos' >Rep\u00fablica Democr\u00e1tica Popular de Laos<\/option><option value='Rep\u00fablica Dominicana' >Rep\u00fablica Dominicana<\/option><option value='Rep\u00fablica \u00c1rabe de Siria' >Rep\u00fablica \u00c1rabe de Siria<\/option><option value='Reuni\u00f3n' >Reuni\u00f3n<\/option><option value='Ruanda' >Ruanda<\/option><option value='Ruman\u00eda' >Ruman\u00eda<\/option><option value='Sahara Occidental' >Sahara Occidental<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='San Bartolom\u00e9' >San Bartolom\u00e9<\/option><option value='San Crist\u00f3bal y Nieves' >San Crist\u00f3bal y Nieves<\/option><option value='San Marino' >San Marino<\/option><option value='San Mart\u00edn' >San Mart\u00edn<\/option><option value='San Pedro y Miquel\u00f3n' >San Pedro y Miquel\u00f3n<\/option><option value='San Vicente y las Granadinas' >San Vicente y las Granadinas<\/option><option value='Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a' >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value='Santa Luc\u00eda' >Santa Luc\u00eda<\/option><option value='Santa Sede' >Santa Sede<\/option><option value='Santo Tom\u00e9 y Principe' >Santo Tom\u00e9 y Principe<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leona' >Sierra Leona<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Somalia' >Somalia<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sud\u00e1frica' >Sud\u00e1frica<\/option><option value='Sud\u00e1n' >Sud\u00e1n<\/option><option value='Sud\u00e1n del Sur' >Sud\u00e1n del Sur<\/option><option value='Suecia' >Suecia<\/option><option value='Suiza' >Suiza<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard y Jan Mayen' >Svalbard y Jan Mayen<\/option><option value='Tailandia' >Tailandia<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tanzania (Rep\u00fablica Unida de)' >Tanzania (Rep\u00fablica Unida de)<\/option><option value='Tayikist\u00e1n' >Tayikist\u00e1n<\/option><option value='Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico' >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value='Tierras Australes y Ant\u00e1rticas Francesas' >Tierras Australes y Ant\u00e1rticas Francesas<\/option><option value='Timor Oriental' >Timor Oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad y Tobago' >Trinidad y Tobago<\/option><option value='Turkmenist\u00e1n' >Turkmenist\u00e1n<\/option><option value='Turqu\u00eda' >Turqu\u00eda<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fanez' >T\u00fanez<\/option><option value='Ucrania' >Ucrania<\/option><option value='Uganda' >Uganda<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekist\u00e1n' >Uzbekist\u00e1n<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis y Futuna' >Wallis y Futuna<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbaue' >Zimbaue<\/option><\/select>\n                                        <label for='input_21_6_6' id='input_21_6_6_label' class='gform-field-label gform-field-label--type-sub '>Pa\u00eds<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">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\"  ><label class='gfield_label gform-field-label' for='input_21_14'>Ort<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_21_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_11\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-seven-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Datum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_21_11' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_21_11_2_container'><label for='input_21_11_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Tag<\/label><select name='input_11[]' id='input_21_11_2'   aria-required='true'  ><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' 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' 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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Zeit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_21_10'>\n                            <input type='number' name='input_10[]' id='input_21_10_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='true'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_21_10_1'>Horas<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_10[]' id='input_21_10_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_21_10_2'>Minutos<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><div id=\"field_21_67\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_67'>Stra\u00dfe\/Kreuzung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_21_67' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_68'>Linie\/Fahrtnummer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_21_68' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_71'>Haltestelle<\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_21_71' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_69'>Bus-Kennzeichen<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_21_69' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_70'>Name Fahrer\/-in<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_21_70' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_48\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_48'>Unfallschilderung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_48' id='input_21_48' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_21_76\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_21_76'>Datei<\/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\\\/wolfsburg\\\/?gf_page=e39fd3a7eb4da38&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Archivos permitidos&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;bdb4139ed2&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'>Suelta archivos aqu\u00ed o <\/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\"  >Selecciona archivos<\/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'>Tama\u00f1o m\u00e1ximo de archivo: 32 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_21_76'><\/ul> <div id='gform_preview_21_76' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_21_23\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">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\"  ><legend class='gfield_label gform-field-label' >Gibt es Zeugen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_81'>\n\t\t\t<div class='gchoice gchoice_21_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Ja'  id='choice_21_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_81_0' id='label_21_81_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_20'>\n                            \n                            <span id='input_21_20_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.3' id='input_21_20_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_20_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_20_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.6' id='input_21_20_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_20_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_17\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_21_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_21_17_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_17_1' id='input_21_17_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/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 '>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_17.4' id='input_21_17_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_21_17_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_17_5' id='input_21_17_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_21_17_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_21\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_21'>Telefon<\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_21_21' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gibt es weitere Zeugen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_80'>\n\t\t\t<div class='gchoice gchoice_21_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Ja'  id='choice_21_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_80_0' id='label_21_80_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_24'>\n                            \n                            <span id='input_21_24_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.3' id='input_21_24_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_24_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_24_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.6' id='input_21_24_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_24_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_25\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_21_25' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_25_1_container' >\n                                        <input type='text' name='input_25.1' id='input_21_25_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_25_1' id='input_21_25_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/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 '>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_25.4' id='input_21_25_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_25_5_container' >\n                                    <input type='text' name='input_25.5' id='input_21_25_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_25_5' id='input_21_25_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_25.6' id='input_21_25_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_26\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_26'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_26' id='input_21_26' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_27\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">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\"  ><label class='gfield_label gform-field-label' for='input_21_28'>Dienststelle<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_21_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_82'>Vorgangsnummer<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_21_82' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_30\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_21_30' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_30_1_container' >\n                                        <input type='text' name='input_30.1' id='input_21_30_1' value=''    aria-required='false'    \/>\n                                        <label for='input_21_30_1' id='input_21_30_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/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 '>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_30.4' id='input_21_30_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_30_5_container' >\n                                    <input type='text' name='input_30.5' id='input_21_30_5' value=''    aria-required='false'    \/>\n                                    <label for='input_21_30_5' id='input_21_30_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_30.6' id='input_21_30_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_77\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_77'>Datei<\/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'>Tama\u00f1o m\u00e1ximo de archivo: 32 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_21_77'><\/div> <\/div><\/div><div id=\"field_21_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">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\"  ><legend class='gfield_label gform-field-label' >Liegt eine Sachbesch\u00e4digung vor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_72'>\n\t\t\t<div class='gchoice gchoice_21_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Ja'  id='choice_21_72_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_72_0' id='label_21_72_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><label class='gfield_label gform-field-label' for='input_21_32'>Was wurde besch\u00e4digt?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_21_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_33\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Eigent\u00fcmer (evtl. Leasinggeber)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_33'>\n                            \n                            <span id='input_21_33_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.3' id='input_21_33_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_33_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_33_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.6' id='input_21_33_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_33_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vorsteuerabzugsberechtigt?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_34'>\n\t\t\t<div class='gchoice gchoice_21_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Ja'  id='choice_21_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_34_0' id='label_21_34_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><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\"  ><legend class='gfield_label gform-field-label' >Liegt eine Besch\u00e4digung an einem Kraftfahrzeug vor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_73'>\n\t\t\t<div class='gchoice gchoice_21_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Ja'  id='choice_21_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_73_0' id='label_21_73_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><label class='gfield_label gform-field-label' for='input_21_36'>Art<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\"  ><label class='gfield_label gform-field-label' for='input_21_37'>Hersteller<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_21_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_38'>Typ<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_21_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_39'>Amtl. Kennzeichen<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_21_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_40'>Versicherung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_21_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_41\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">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\"  ><legend class='gfield_label gform-field-label' >Liegen Personensch\u00e4den vor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_74'>\n\t\t\t<div class='gchoice gchoice_21_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Ja'  id='choice_21_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_74_0' id='label_21_74_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><label class='gfield_label gform-field-label' for='input_21_42'>Anrede<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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_43'>\n                            \n                            <span id='input_21_43_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_43.3' id='input_21_43_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_43_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_43_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_43.6' id='input_21_43_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_43_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_44\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_21_44' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_44_1_container' >\n                                        <input type='text' name='input_44.1' id='input_21_44_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_44_1' id='input_21_44_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/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 '>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_44.4' id='input_21_44_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_44_5_container' >\n                                    <input type='text' name='input_44.5' id='input_21_44_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_44_5' id='input_21_44_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ C\u00f3digo Postal<\/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='Afghanist\u00e1n' >Afghanist\u00e1n<\/option><option value='Albania' >Albania<\/option><option value='Alemania' >Alemania<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antigua y Barbuda' >Antigua y Barbuda<\/option><option value='Ant\u00e1rtida' >Ant\u00e1rtida<\/option><option value='Arabia Saudita' >Arabia Saudita<\/option><option value='Argelia' >Argelia<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaiy\u00e1n' >Azerbaiy\u00e1n<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Bar\u00e9in' >Bar\u00e9in<\/option><option value='Belice' >Belice<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhut\u00e1n' >Bhut\u00e1n<\/option><option value='Bielorusia' >Bielorusia<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, San Eustaquio y Saba' >Bonaire, San Eustaquio y Saba<\/option><option value='Bosnia y Herzegovina' >Bosnia y Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brasil' >Brasil<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9lgica' >B\u00e9lgica<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Camboya' >Camboya<\/option><option value='Camer\u00fan' >Camer\u00fan<\/option><option value='Canada' >Canada<\/option><option value='Chad' >Chad<\/option><option value='Chequia' >Chequia<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Chipre' >Chipre<\/option><option value='Colombia' >Colombia<\/option><option value='Comoras' >Comoras<\/option><option value='Congo' >Congo<\/option><option value='Congo, Rep\u00fablica Democr\u00e1tica del' >Congo, Rep\u00fablica Democr\u00e1tica del<\/option><option value='Corea, Rep\u00fablica Popular Democr\u00e1tica de' >Corea, Rep\u00fablica Popular Democr\u00e1tica de<\/option><option value='Corea, Rep\u00fablica de' >Corea, Rep\u00fablica de<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Costa de Marfil' >Costa de Marfil<\/option><option value='Croacia' >Croacia<\/option><option value='Cuba' >Cuba<\/option><option value='Curazao' >Curazao<\/option><option value='Dinamarca' >Dinamarca<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egipto' >Egipto<\/option><option value='El Salvador' >El Salvador<\/option><option value='Emiratos \u00c1rabes Unidos' >Emiratos \u00c1rabes Unidos<\/option><option value='Eritrea' >Eritrea<\/option><option value='Eslovaquia' >Eslovaquia<\/option><option value='Eslovenia' >Eslovenia<\/option><option value='Espa\u00f1a' >Espa\u00f1a<\/option><option value='Estados Unidos' >Estados Unidos<\/option><option value='Estonia' >Estonia<\/option><option value='Esuatini' >Esuatini<\/option><option value='Etiop\u00eda' >Etiop\u00eda<\/option><option value='Federaci\u00f3n Rusa' >Federaci\u00f3n Rusa<\/option><option value='Fiji' >Fiji<\/option><option value='Filipinas' >Filipinas<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francia' >Francia<\/option><option value='Gab\u00f3n' >Gab\u00f3n<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Granada' >Granada<\/option><option value='Grecia' >Grecia<\/option><option value='Groenlandia' >Groenlandia<\/option><option value='Guadalupe' >Guadalupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guayana' >Guayana<\/option><option value='Guayana Francesa' >Guayana Francesa<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea Bissau' >Guinea Bissau<\/option><option value='Guinea Ecuatorial' >Guinea Ecuatorial<\/option><option value='Hait\u00ed' >Hait\u00ed<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungr\u00eda' >Hungr\u00eda<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iraq' >Iraq<\/option><option value='Irlanda' >Irlanda<\/option><option value='Ir\u00e1n' >Ir\u00e1n<\/option><option value='Isla Bouvet' >Isla Bouvet<\/option><option value='Isla Norfolk' >Isla Norfolk<\/option><option value='Isla de Man' >Isla de Man<\/option><option value='Isla de Navidad' >Isla de Navidad<\/option><option value='Islandia' >Islandia<\/option><option value='Islas Caim\u00e1n' >Islas Caim\u00e1n<\/option><option value='Islas Cocos' >Islas Cocos<\/option><option value='Islas Cook' >Islas Cook<\/option><option value='Islas Faroe' >Islas Faroe<\/option><option value='Islas Heard y McDonald' >Islas Heard y McDonald<\/option><option value='Islas Malvinas' >Islas Malvinas<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Islas Marshall' >Islas Marshall<\/option><option value='Islas Salom\u00f3n' >Islas Salom\u00f3n<\/option><option value='Islas Turcas y Caicos' >Islas Turcas y Caicos<\/option><option value='Islas Ultramarinas Menores de Estados Unidos' >Islas Ultramarinas Menores de Estados Unidos<\/option><option value='Islas V\u00edrgenes Brit\u00e1nicas' >Islas V\u00edrgenes Brit\u00e1nicas<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Islas \u00c5land' >Islas \u00c5land<\/option><option value='Israel' >Israel<\/option><option value='Italia' >Italia<\/option><option value='Jamaica' >Jamaica<\/option><option value='Jap\u00f3n' >Jap\u00f3n<\/option><option value='Jersey' >Jersey<\/option><option value='Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='Jord\u00e1n' >Jord\u00e1n<\/option><option value='Kazajist\u00e1n' >Kazajist\u00e1n<\/option><option value='Kenia' >Kenia<\/option><option value='Kirguist\u00e1n' >Kirguist\u00e1n<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='LIbia' >LIbia<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liberia' >Liberia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituania' >Lituania<\/option><option value='Lituania' >Lituania<\/option><option value='Luxemburgo' >Luxemburgo<\/option><option value='L\u00edbano' >L\u00edbano<\/option><option value='Macau' >Macau<\/option><option value='Macedonia del Norte' >Macedonia del Norte<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malasia' >Malasia<\/option><option value='Malawi' >Malawi<\/option><option value='Maldivas' >Maldivas<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marruecos' >Marruecos<\/option><option value='Martinica' >Martinica<\/option><option value='Mauricio' >Mauricio<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mayotte' >Mayotte<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldavia' >Moldavia<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='M\u00e9xico' >M\u00e9xico<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noruega' >Noruega<\/option><option value='Nueva Caledonia' >Nueva Caledonia<\/option><option value='Nueva Zelanda' >Nueva Zelanda<\/option><option value='N\u00edger' >N\u00edger<\/option><option value='Om\u00e1n' >Om\u00e1n<\/option><option value='Paises Bajos' >Paises Bajos<\/option><option value='Pakist\u00e1n' >Pakist\u00e1n<\/option><option value='Palau' >Palau<\/option><option value='Palestina, Estado de' >Palestina, Estado de<\/option><option value='Panam\u00e1' >Panam\u00e1<\/option><option value='Pap\u00faa Nueva Guinea' >Pap\u00faa Nueva Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Per\u00fa' >Per\u00fa<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinesia Francesa' >Polinesia Francesa<\/option><option value='Polonia' >Polonia<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Reino Unido' >Reino Unido<\/option><option value='Rep\u00fablica Centroafricana' >Rep\u00fablica Centroafricana<\/option><option value='Rep\u00fablica Democr\u00e1tica Popular de Laos' >Rep\u00fablica Democr\u00e1tica Popular de Laos<\/option><option value='Rep\u00fablica Dominicana' >Rep\u00fablica Dominicana<\/option><option value='Rep\u00fablica \u00c1rabe de Siria' >Rep\u00fablica \u00c1rabe de Siria<\/option><option value='Reuni\u00f3n' >Reuni\u00f3n<\/option><option value='Ruanda' >Ruanda<\/option><option value='Ruman\u00eda' >Ruman\u00eda<\/option><option value='Sahara Occidental' >Sahara Occidental<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='San Bartolom\u00e9' >San Bartolom\u00e9<\/option><option value='San Crist\u00f3bal y Nieves' >San Crist\u00f3bal y Nieves<\/option><option value='San Marino' >San Marino<\/option><option value='San Mart\u00edn' >San Mart\u00edn<\/option><option value='San Pedro y Miquel\u00f3n' >San Pedro y Miquel\u00f3n<\/option><option value='San Vicente y las Granadinas' >San Vicente y las Granadinas<\/option><option value='Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a' >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value='Santa Luc\u00eda' >Santa Luc\u00eda<\/option><option value='Santa Sede' >Santa Sede<\/option><option value='Santo Tom\u00e9 y Principe' >Santo Tom\u00e9 y Principe<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leona' >Sierra Leona<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Somalia' >Somalia<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sud\u00e1frica' >Sud\u00e1frica<\/option><option value='Sud\u00e1n' >Sud\u00e1n<\/option><option value='Sud\u00e1n del Sur' >Sud\u00e1n del Sur<\/option><option value='Suecia' >Suecia<\/option><option value='Suiza' >Suiza<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard y Jan Mayen' >Svalbard y Jan Mayen<\/option><option value='Tailandia' >Tailandia<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tanzania (Rep\u00fablica Unida de)' >Tanzania (Rep\u00fablica Unida de)<\/option><option value='Tayikist\u00e1n' >Tayikist\u00e1n<\/option><option value='Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico' >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value='Tierras Australes y Ant\u00e1rticas Francesas' >Tierras Australes y Ant\u00e1rticas Francesas<\/option><option value='Timor Oriental' >Timor Oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad y Tobago' >Trinidad y Tobago<\/option><option value='Turkmenist\u00e1n' >Turkmenist\u00e1n<\/option><option value='Turqu\u00eda' >Turqu\u00eda<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fanez' >T\u00fanez<\/option><option value='Ucrania' >Ucrania<\/option><option value='Uganda' >Uganda<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekist\u00e1n' >Uzbekist\u00e1n<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis y Futuna' >Wallis y Futuna<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbaue' >Zimbaue<\/option><\/select>\n                                        <label for='input_21_44_6' id='input_21_44_6_label' class='gform-field-label gform-field-label--type-sub '>Pa\u00eds<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_45\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_45'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_45' id='input_21_45' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_46\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_46'>E-Mail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_46' id='input_21_46' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_21_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_47'>Art und Umfang der Verletzung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_21_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_49\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Sicherheitsgurt angelegt?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_49'>\n\t\t\t<div class='gchoice gchoice_21_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Ja'  id='choice_21_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_49_0' id='label_21_49_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><legend class='gfield_label gform-field-label' >Krankenhausaufenthalt?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_50'>\n\t\t\t<div class='gchoice gchoice_21_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Ja'  id='choice_21_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_50_0' id='label_21_50_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><label class='gfield_label gform-field-label' for='input_21_51'>Welches Krankenhaus?<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_21_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_21_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_63'>\n\t\t\t<div class='gchoice gchoice_21_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Ja'  id='choice_21_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_63_0' id='label_21_63_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><legend class='gfield_label gform-field-label' >Ist der Verletzte gesetzlich rentenversichert?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_64'>\n\t\t\t<div class='gchoice gchoice_21_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Ja'  id='choice_21_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_64_0' id='label_21_64_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><legend class='gfield_label gform-field-label' >Wurden weitere Personen verletzt?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_75'>\n\t\t\t<div class='gchoice gchoice_21_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Ja'  id='choice_21_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_21_75_0' id='label_21_75_0' class='gform-field-label gform-field-label--type-inline'>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\"  ><label class='gfield_label gform-field-label' for='input_21_52'>Anrede<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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_53'>\n                            \n                            <span id='input_21_53_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_53.3' id='input_21_53_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_53_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_53_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_53.6' id='input_21_53_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_21_53_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_21_54\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anschrift<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_21_54' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_54_1_container' >\n                                        <input type='text' name='input_54.1' id='input_21_54_1' value=''    aria-required='true'    \/>\n                                        <label for='input_21_54_1' id='input_21_54_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/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 '>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_54.4' id='input_21_54_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_54_5_container' >\n                                    <input type='text' name='input_54.5' id='input_21_54_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_54_5' id='input_21_54_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ C\u00f3digo Postal<\/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='Afghanist\u00e1n' >Afghanist\u00e1n<\/option><option value='Albania' >Albania<\/option><option value='Alemania' >Alemania<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antigua y Barbuda' >Antigua y Barbuda<\/option><option value='Ant\u00e1rtida' >Ant\u00e1rtida<\/option><option value='Arabia Saudita' >Arabia Saudita<\/option><option value='Argelia' >Argelia<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaiy\u00e1n' >Azerbaiy\u00e1n<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Bar\u00e9in' >Bar\u00e9in<\/option><option value='Belice' >Belice<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhut\u00e1n' >Bhut\u00e1n<\/option><option value='Bielorusia' >Bielorusia<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, San Eustaquio y Saba' >Bonaire, San Eustaquio y Saba<\/option><option value='Bosnia y Herzegovina' >Bosnia y Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brasil' >Brasil<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9lgica' >B\u00e9lgica<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Camboya' >Camboya<\/option><option value='Camer\u00fan' >Camer\u00fan<\/option><option value='Canada' >Canada<\/option><option value='Chad' >Chad<\/option><option value='Chequia' >Chequia<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Chipre' >Chipre<\/option><option value='Colombia' >Colombia<\/option><option value='Comoras' >Comoras<\/option><option value='Congo' >Congo<\/option><option value='Congo, Rep\u00fablica Democr\u00e1tica del' >Congo, Rep\u00fablica Democr\u00e1tica del<\/option><option value='Corea, Rep\u00fablica Popular Democr\u00e1tica de' >Corea, Rep\u00fablica Popular Democr\u00e1tica de<\/option><option value='Corea, Rep\u00fablica de' >Corea, Rep\u00fablica de<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Costa de Marfil' >Costa de Marfil<\/option><option value='Croacia' >Croacia<\/option><option value='Cuba' >Cuba<\/option><option value='Curazao' >Curazao<\/option><option value='Dinamarca' >Dinamarca<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egipto' >Egipto<\/option><option value='El Salvador' >El Salvador<\/option><option value='Emiratos \u00c1rabes Unidos' >Emiratos \u00c1rabes Unidos<\/option><option value='Eritrea' >Eritrea<\/option><option value='Eslovaquia' >Eslovaquia<\/option><option value='Eslovenia' >Eslovenia<\/option><option value='Espa\u00f1a' >Espa\u00f1a<\/option><option value='Estados Unidos' >Estados Unidos<\/option><option value='Estonia' >Estonia<\/option><option value='Esuatini' >Esuatini<\/option><option value='Etiop\u00eda' >Etiop\u00eda<\/option><option value='Federaci\u00f3n Rusa' >Federaci\u00f3n Rusa<\/option><option value='Fiji' >Fiji<\/option><option value='Filipinas' >Filipinas<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francia' >Francia<\/option><option value='Gab\u00f3n' >Gab\u00f3n<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Granada' >Granada<\/option><option value='Grecia' >Grecia<\/option><option value='Groenlandia' >Groenlandia<\/option><option value='Guadalupe' >Guadalupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guayana' >Guayana<\/option><option value='Guayana Francesa' >Guayana Francesa<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea Bissau' >Guinea Bissau<\/option><option value='Guinea Ecuatorial' >Guinea Ecuatorial<\/option><option value='Hait\u00ed' >Hait\u00ed<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungr\u00eda' >Hungr\u00eda<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iraq' >Iraq<\/option><option value='Irlanda' >Irlanda<\/option><option value='Ir\u00e1n' >Ir\u00e1n<\/option><option value='Isla Bouvet' >Isla Bouvet<\/option><option value='Isla Norfolk' >Isla Norfolk<\/option><option value='Isla de Man' >Isla de Man<\/option><option value='Isla de Navidad' >Isla de Navidad<\/option><option value='Islandia' >Islandia<\/option><option value='Islas Caim\u00e1n' >Islas Caim\u00e1n<\/option><option value='Islas Cocos' >Islas Cocos<\/option><option value='Islas Cook' >Islas Cook<\/option><option value='Islas Faroe' >Islas Faroe<\/option><option value='Islas Heard y McDonald' >Islas Heard y McDonald<\/option><option value='Islas Malvinas' >Islas Malvinas<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Islas Marshall' >Islas Marshall<\/option><option value='Islas Salom\u00f3n' >Islas Salom\u00f3n<\/option><option value='Islas Turcas y Caicos' >Islas Turcas y Caicos<\/option><option value='Islas Ultramarinas Menores de Estados Unidos' >Islas Ultramarinas Menores de Estados Unidos<\/option><option value='Islas V\u00edrgenes Brit\u00e1nicas' >Islas V\u00edrgenes Brit\u00e1nicas<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Islas \u00c5land' >Islas \u00c5land<\/option><option value='Israel' >Israel<\/option><option value='Italia' >Italia<\/option><option value='Jamaica' >Jamaica<\/option><option value='Jap\u00f3n' >Jap\u00f3n<\/option><option value='Jersey' >Jersey<\/option><option value='Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy' >Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='Jord\u00e1n' >Jord\u00e1n<\/option><option value='Kazajist\u00e1n' >Kazajist\u00e1n<\/option><option value='Kenia' >Kenia<\/option><option value='Kirguist\u00e1n' >Kirguist\u00e1n<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='LIbia' >LIbia<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liberia' >Liberia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituania' >Lituania<\/option><option value='Lituania' >Lituania<\/option><option value='Luxemburgo' >Luxemburgo<\/option><option value='L\u00edbano' >L\u00edbano<\/option><option value='Macau' >Macau<\/option><option value='Macedonia del Norte' >Macedonia del Norte<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malasia' >Malasia<\/option><option value='Malawi' >Malawi<\/option><option value='Maldivas' >Maldivas<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marruecos' >Marruecos<\/option><option value='Martinica' >Martinica<\/option><option value='Mauricio' >Mauricio<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mayotte' >Mayotte<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldavia' >Moldavia<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='M\u00e9xico' >M\u00e9xico<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noruega' >Noruega<\/option><option value='Nueva Caledonia' >Nueva Caledonia<\/option><option value='Nueva Zelanda' >Nueva Zelanda<\/option><option value='N\u00edger' >N\u00edger<\/option><option value='Om\u00e1n' >Om\u00e1n<\/option><option value='Paises Bajos' >Paises Bajos<\/option><option value='Pakist\u00e1n' >Pakist\u00e1n<\/option><option value='Palau' >Palau<\/option><option value='Palestina, Estado de' >Palestina, Estado de<\/option><option value='Panam\u00e1' >Panam\u00e1<\/option><option value='Pap\u00faa Nueva Guinea' >Pap\u00faa Nueva Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Per\u00fa' >Per\u00fa<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinesia Francesa' >Polinesia Francesa<\/option><option value='Polonia' >Polonia<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Reino Unido' >Reino Unido<\/option><option value='Rep\u00fablica Centroafricana' >Rep\u00fablica Centroafricana<\/option><option value='Rep\u00fablica Democr\u00e1tica Popular de Laos' >Rep\u00fablica Democr\u00e1tica Popular de Laos<\/option><option value='Rep\u00fablica Dominicana' >Rep\u00fablica Dominicana<\/option><option value='Rep\u00fablica \u00c1rabe de Siria' >Rep\u00fablica \u00c1rabe de Siria<\/option><option value='Reuni\u00f3n' >Reuni\u00f3n<\/option><option value='Ruanda' >Ruanda<\/option><option value='Ruman\u00eda' >Ruman\u00eda<\/option><option value='Sahara Occidental' >Sahara Occidental<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='San Bartolom\u00e9' >San Bartolom\u00e9<\/option><option value='San Crist\u00f3bal y Nieves' >San Crist\u00f3bal y Nieves<\/option><option value='San Marino' >San Marino<\/option><option value='San Mart\u00edn' >San Mart\u00edn<\/option><option value='San Pedro y Miquel\u00f3n' >San Pedro y Miquel\u00f3n<\/option><option value='San Vicente y las Granadinas' >San Vicente y las Granadinas<\/option><option value='Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a' >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value='Santa Luc\u00eda' >Santa Luc\u00eda<\/option><option value='Santa Sede' >Santa Sede<\/option><option value='Santo Tom\u00e9 y Principe' >Santo Tom\u00e9 y Principe<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leona' >Sierra Leona<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Somalia' >Somalia<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sud\u00e1frica' >Sud\u00e1frica<\/option><option value='Sud\u00e1n' >Sud\u00e1n<\/option><option value='Sud\u00e1n del Sur' >Sud\u00e1n del Sur<\/option><option value='Suecia' >Suecia<\/option><option value='Suiza' >Suiza<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard y Jan Mayen' >Svalbard y Jan Mayen<\/option><option value='Tailandia' >Tailandia<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tanzania (Rep\u00fablica Unida de)' >Tanzania (Rep\u00fablica Unida de)<\/option><option value='Tayikist\u00e1n' >Tayikist\u00e1n<\/option><option value='Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico' >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value='Tierras Australes y Ant\u00e1rticas Francesas' >Tierras Australes y Ant\u00e1rticas Francesas<\/option><option value='Timor Oriental' >Timor Oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad y Tobago' >Trinidad y Tobago<\/option><option value='Turkmenist\u00e1n' >Turkmenist\u00e1n<\/option><option value='Turqu\u00eda' >Turqu\u00eda<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fanez' >T\u00fanez<\/option><option value='Ucrania' >Ucrania<\/option><option value='Uganda' >Uganda<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekist\u00e1n' >Uzbekist\u00e1n<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis y Futuna' >Wallis y Futuna<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbaue' >Zimbaue<\/option><\/select>\n                                        <label for='input_21_54_6' id='input_21_54_6_label' class='gform-field-label gform-field-label--type-sub '>Pa\u00eds<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_21_55\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_55'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_55' id='input_21_55' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_56\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_56'>E-Mail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_56' id='input_21_56' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_21_57\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_57'>Art und Umfang der Verletzung<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\"  ><legend class='gfield_label gform-field-label' >Sicherheitsgurt angelegt?<\/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 )'    \/>\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\"  ><legend class='gfield_label gform-field-label' >Krankenhausaufenthalt?<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 )'    \/>\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\"  ><label class='gfield_label gform-field-label' for='input_21_60'>Welches Krankenhaus?<\/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\"  ><legend class='gfield_label gform-field-label' >Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?<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 )'    \/>\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\"  ><legend class='gfield_label gform-field-label' >Ist der Verletzte gesetzlich rentenversichert?<\/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 )'    \/>\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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Einwilligung<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-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_78_1' >Ich stimme der Datenschutzerkl\u00e4rung zu.<\/label><input type='hidden' name='input_78.2' value='Ich stimme der Datenschutzerkl\u00e4rung zu.' 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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-7368a61 elementor-widget elementor-widget-button\" data-id=\"7368a61\" 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 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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-fa32c82 elementor-widget elementor-widget-text-editor\" data-id=\"fa32c82\" 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? 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class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>SCHADENABWICKLUNG BEI UNF\u00c4LLEN Du hattest einen Unfall mit einem unserer Fahrzeugen? Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit den Verkehrsbetrieben Bachstein 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\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* 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 AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. 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Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Wurden weitere Personen verletzt?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? 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Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit den Verkehrsbetrieben Bachstein 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\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* 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 AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Wurden weitere Personen verletzt?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Einwilligung* Ich stimme der Datenschutzerkl\u00e4rung zu. CAPTCHA Fragebogen f\u00fcr Anspruchssteller als Download Solltest du dich f\u00fcr die schriftliche M\u00f6glichkeit entscheide sende uns diesen &#8211; bevorzugt per E-Mail &#8211; an 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. 05141 48708-54 versicherung@kvg-bus.de Wie gut gef\u00e4llt dir unsere Website?HerausragendVorwiegend gutNeutralNicht gutFurchtbarAuf welcher Seite befindest du dich?(erforderlich) M\u00f6chtest du uns sonst noch etwas sagen?\" \/>\n<meta property=\"og:url\" content=\"https:\/\/vb-bachstein.de\/wolfsburg\/servicio\/liquidacion-de-siniestros\/\" \/>\n<meta property=\"og:site_name\" content=\"VB-Wolfsburg\" \/>\n<meta property=\"article:modified_time\" content=\"2026-01-19T13:17:07+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data1\" content=\"10 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/schadenabwicklung\\\/\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/schadenabwicklung\\\/\",\"name\":\"Schadenabwicklung - VB-Wolfsburg\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/schadenabwicklung\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/schadenabwicklung\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/header-subsites_vb-2.jpg\",\"datePublished\":\"2025-11-05T08:50:29+00:00\",\"dateModified\":\"2026-01-19T13:17:07+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/schadenabwicklung\\\/#breadcrumb\"},\"inLanguage\":\"es\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/schadenabwicklung\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/schadenabwicklung\\\/#primaryimage\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/header-subsites_vb-2.jpg\",\"contentUrl\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/header-subsites_vb-2.jpg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/schadenabwicklung\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Startseite\",\"item\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Service\",\"item\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/service\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Schadenabwicklung\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/#website\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/\",\"name\":\"VB-Wolfsburg\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"es\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/#organization\",\"name\":\"VB-Wolfsburg\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/vb-bachstein_logo.svg\",\"contentUrl\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/wp-content\\\/uploads\\\/sites\\\/14\\\/vb-bachstein_logo.svg\",\"caption\":\"VB-Wolfsburg\"},\"image\":{\"@id\":\"https:\\\/\\\/vb-bachstein.de\\\/wolfsburg\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Gesti\u00f3n de siniestros - VB-Wolfsburg","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\/wolfsburg\/servicio\/liquidacion-de-siniestros\/","og_locale":"es_ES","og_type":"article","og_title":"Schadenabwicklung - VB-Wolfsburg","og_description":"SCHADENABWICKLUNG BEI UNF\u00c4LLEN Du hattest einen Unfall mit einem unserer Fahrzeugen? Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit den Verkehrsbetrieben Bachstein 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\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* 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 AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Wurden weitere Personen verletzt?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#8217;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. 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