CLAIM APPLICATION FORM

Please fill the questionnaire and express your opinion about us. Our goal is to be focused on your requirements and provide you with consecutively improving service.  Your opinion is very important for us.

INFORMATION ABOUT CLIENT:

INFORMATION ABOUT CLAIMANT

(SHOULD BE FILLED, IF THE CLAIM IS MADE BY THE REPRESENTATIVE OF INSURED)

INFORMATION ABOUT INSURANCE PRODUCT(S) OR SERVICE(S)

PLEASE MARK PRODUCT(S), WHICH CAUSED YOUR CLAIM

TYPE OF CLAIM

DESIRED FORM FOR RECEIVING THE ANSWER

DESCRIBE THE CONTENT OF YOUR CLAIM

DECLARATION

1) Datas indicated in this questionnaire are exact and reliable. For representating this application, I own appropriate authority or/and I have obtained all needed permission(s);

2) I am completely responsible for any damage or loss, caused to the insurer, by posting this claim;

3) Application, represented by electronic form, is equal in legal force to material version.


After receiving the claim during, no more than 2 working days, we will provide you with information about responsible person about your matter and additional documentation, which should be represented;

During 10 working days you will receive a complete answer about your claim;

In case, it will be unavailable to provide you with complete answer in abovementioned deadlines, you will be provided with the reason of delay and a highest possible deadline.