universal claim notification form

Event notification

EVENT INFORMATION

Event circumstances*

INFORMATION ABOUT POLICYHOLDER

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

SUPPORTING DOCUMENTS

The size of a single attached document should not exceed 5MB, and the maximum size of all documents should not exceed 30MB. Allowed file types: pdf, jpg, doc, xls, zip, 7z, bmp, png.

Attach documents (photo of damages, third parties claims document, other)

Details of the notifier

* - Mandatory fields