File a claim

Name

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First name

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Full address

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E-mail

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Phone / mobile

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Policy number(s)

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Date of damage occurring

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Time of accident

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Where did the event take place ?

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What exactly happened ?

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Extent and description of the damage

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Identity of other party

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Report number

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Upload a file

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Additional question or information

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How much is six + 3 ? (*)

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Damage Claim