Claim Notification

Claim notification

Name *

Company

Street *

Postal Code *

Place *

E-Mail *

Policy number / Reference *

IBAN Nr.

Name and place of bank *

Date of event *

Information in respect of the damage event

Place *

Information in respect of the damage event

Description of the course of events *

Information in respect of the damage event

Has the claim been reported to the police *

Who has caused the damage *

File Upload

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