Please fill in the required fields below and click Confirm Details.
Please put a space between your first and last name.
Please ensure your mobile phone is available for use in Japan so you can contact the shop or police in an emergency. (Required)
Please attach a photo of the vehicle's license plate.
※Videos cannot be attached.
*Please attach photos of the vehicle, photos showing the accident situation, and a photo of the business card of the police officer who responded.
Upload Photo
Please select from the calendar.
Please enter the approximate time of occurrence.
If the current location on the map differs from the accident location, tap the pin and indicate the correct position.
※If location services are not enabled, you can specify the location manually.If you have not allowed location services, please enter the location shown on the screen when prompted.You may also specify the location by selecting it from the larger map.
Please fill in the situation of the accident. If there is another party involved, please also fill in the information of the other party.
(Ex.: Name, telephone number, vehicle type, vehicle registration number, etc. of the other party)
*Videos cannot be attached.
*Please note that this is not covered by the warranty if you have not submitted a notification.
Please review the Privacy Policy and proceed if you agree.
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