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Property insurance

Event notification

EVENT INFORMATION

Event date*

Event time

Event country*

Event address ( address, city)*

Event circumstances*

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Was damage caused to others persons property?*

INFORMATION ABOUT POLICYHOLDER

Policyholder is private person

Policyholder is legal person

Personal ID or Insurance policy number*

Name*

Surname*

E-mail*

Phone number*

IN CASE OF THE INSURED EVENT, PLEASE TRANSFER THE INSURANCE BENEFIT TO

Beneficiary is the policyholder

Personal ID/Company code

Name Surname/Company name

Bank account

SUPPORTING DOCUMENTS

Attach documents (photo of damages, property ownership document etc.)

Attach documents

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DETAILS OF THE NOTIFIER

Notifier is the policyholder

Personal identification number*

Name*

Surname*

Address*

Phone number*

E-mail*

I confirm I have read the Privacy policy, the information I have provided is correct and I am fully authorized to submit this claim application and, upon request of Balcia, I will provide other necessary data and documents. I am aware of and agree on the mutual communication (including document submission) via email.

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I agree to receive information about promotions, discounts, bonuses and other marketing activities, including requests for my opinion about Balcia services.

*Mandatory fields