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