BCVLex 29/10/2020 Kathleen Doyeux Personal information E-mail* First name* Country of residence* Telephone number* Profession Purpose of the consultation —Select an objectPersonal Injury / Injury / AccidentSuccessionOther consultations Information regarding the incident 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 Attach images (maximum size 2MB) Have you filed a complaint for these facts with the Police?* NoYes Attach images (maximum size 2MB) Were you taken care of by the emergency services (firefighters, ambulance)?* NoYes Did you consult a doctor or hospital following the incident?* NoYes If so, in which hospital Do you have medical reports from the day of the accident?* NoYes Attach medical report (maximum size 2MB) Do you have any subsequent medical reports? NoYes Attach medical report (maximum size 2MB) Informations regarding the victim Victim's employment status at the time of the incident* —Please choose an option—Employee / civil servantIndipendentRetirement / Pension / Entry / BenefitOther Specify employment status Information regarding the damage / injuries What injuries did you sustain as a result of the incident?* Have you been on sick leave?* NoYes If applicable, please indicate the period of absence from work Have you had any loss of professional earnings?* NoYes If applicable, indicate the estimated loss Do you have any out-of-pocket expenses related to the index (health expenses, miscellaneous expenses)* NoYes If applicable, please list them and indicate if you have the following documents Information about the deceased Date of death* Place of death* Place of last residence of the deceased* Had the deceased made a will? NoYesI don´t know If applicable (France / Spain) SpainFrance Information on the heir(s) Number of heirs to the estate Do the heirs all agree to settle the estate?* YesNo If no, what is the difficulty Do all heirs have a NIE (Foreigner's Identity Number) in Spain? YesNo Inheritance information Is the inheritance being handled by a Notary?* NoYes If so, in which country? Is the estate made up of real estate? NoYes Where applicable, addresses and value of real estate* Do the heirs want the real estate? NoYes Is the estate made up of bank accounts? NoYes If applicable, please indicate the balance of the accounts Is the estate made up of other assets NoYes If applicable, please list the items and their approximate value Specify the object* How did you hear about us? On recommendationOn the internetOther I agree that this data will be kept and may be used to evaluate my file, until the intake service has taken my form into consideration.* Click hereaquí to read our privacy statement. 0
