Report a claim

To report a claim, fill in the form below; beware, all fields are mandatory

*Atention: All fields are mandatory.

If you have difficulty completing the form, please contact us by phone at +40 21 202 96 90


Insurance policy no.


Insurer’s name



Location


Country


City


Incident date


Incident hour


Incident details


Claim value


Notes / instructions


Name


Company


E-mail


Phone number




Attach files


File 1


File 2


File 3


File 4