European Claim Form

In order to have your claims notification handled, you should take the following steps, within 2 weeks after the date of the burglary/damage:

We can only accept your claim if we receive all the necessary documents with 1 month after the burglary/damage.

Name *

Contract number *

Subscriber

Last name *

First name *

Company name *

Address *

Postal code *

Town *

Country *

Telephone

Fax

E-mail *

Comments

Description of accident/damage *

Date *

Day

Month

Year

Time *

Hour

Minute

Cause *

Do you have an other insurance? *

yes

Appendices

Please select from the list below the appendices that are appropriate to your situation:

In case of burglary:

Official report (police)

Offer for replacing asset

Proof of burglary damage (pictures, repair invoice burglary damage)

Word/Excel sheet of the stolen assets

In case of damage:

Repair company’s estimate for cost of repair

Word/Excel of the damaged assets

Please add the attachments here. *

(Allowed file formats: .pdf, .doc, .docx, .rtf, .txt, xls, xlsx, .gif, .jpg)