Request for claims history certificate

This form is only available for clients of KBC Autolease.

1Contact details

Company

Driver's first name

Driver's surname

Mobile or landline number

E-mail address

Vehicle registration plate

2If several registration plate numbers

Vehicle registration plate 2

Vehicle registration plate 3

KBC Autolease aims to process your personal data in a manner that is lawful, appropriate and transparent. Further details about how we process and share your personal data are set out in our privacy statement. It explains your rights and how you can exercise them. Our privacy statement is available at www.kbc.be/autolease/privacy, at your branch or from your intermediary and is regularly revised.