Legal claim notice

Policy number*

First and last name *

Phone number

E-mail address*

Date when event occurred*

Location where event occurred*

Full name / business name of the counterparty*

Counterparty e-mail

Counterparty phone

Counterparty ID code

Counterparty address

Event description*

Claim to the counterparty*

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Legal claim notice

Upload documents related to the case (total maximum 20Mb)

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