Date of the incident that caused the injuries*

Location of the incident

Exact circumstances of the incident that caused the injuries*

Do you have photographs of the accident site?
NoYes

Have you filed a complaint for these facts with the Police?*
NoYes

Were you taken care of by the emergency services (firefighters, ambulance)?*
NoYes

Did you consult a doctor or hospital following the incident?*
NoYes

Victim's employment status at the time of the incident*
—Please choose an option—Employee / civil servantIndipendentRetirement / Pension / Entry / BenefitOther

What injuries did you sustain as a result of the incident?*

Have you been on sick leave?*
NoYes

Have you had any loss of professional earnings?*
NoYes

Do you have any out-of-pocket expenses related to the index (health expenses, miscellaneous expenses)*
NoYes

Date of death*

Place of death*

Place of last residence of the deceased*

Had the deceased made a will?
NoYesI don´t know

Number of heirs to the estate

Do the heirs all agree to settle the estate?*
YesNo

Do all heirs have a NIE (Foreigner's Identity Number) in Spain?
YesNo

Is the inheritance being handled by a Notary?*
NoYes