Customer service

Self-service

Do you have damage to claim? Please fill in the form below as fully as possible and we will do our best to process your claim as quickly as we can. Please include relevant photos and a sketch of the situation when you submit your claim. When you have submitted the completed form, you will receive confirmation of receipt and we will inform you of the status of your claim.

Fields marked with * are mandatory.

Contact details

Name *

Name is required

E-mail *

E-mail is required

Enter a valid e-mail address

Phone *

Phone is required

Enter a valid phone number. Permitted characters are numbers (0-9), spaces and plus and minus signs.

Street *

Street is required

House number *

House number is required

Postcode *

Postcode is required

Enter a valid Belgian postcode.

Town/city *

Town/city is required

Country *

Country is required

Number plate *

Location and date

City *

City is required

Facility *

Facility is required

Date and time *

Enter the date and time of the incident.

Details

Circumstances *

Description of the cause and circumstances of the damage.

Circumstances is required

Witnesses

Please provide the identity of any witnesses, including address.

Witnesses is required

Attachments

Upload

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Uploads

Saved documents

Damage

Material damage *

Personal injury *

Material damage

Description *

Description of the material damage.

Description is required

User

Yes

Is the person submitting the claim also the user of the damaged items?

Insured

Yes

Are the damaged goods insured?

Insurance company

The insurance company that insures the items.

Insurance company is required

Personal injury

Description *

Please describe the personal injuries/wounds.

Description is required

Occupation

Occupation is required

Age

Age is required

Privacy

I accept the Q-Park privacy statement.