Accident claim
Claim application
Report a claim | Personal accident insurance | If Insurance
Claim applicant and sufferers
Required
Only latin characters allowed
Required
Only latin characters allowed
Required
Required
Check the phone number
Required
Check the e-mail address
Sufferers
Required
Required
Sufferer
Required
Only latin characters allowed
Required
Only latin characters allowed
Required
Check the phone number
Check the phone number
Check the e-mail address
Name {{ model.submitter.name }}
Surname {{ model.submitter.surname }}
ID code {{ model.submitter.code }}
Phone number {{ model.submitter.phoneNumber }}
Email {{ model.submitter.email }}
Sufferers
You are the sufferer? Yes No
Other sufferers
Name {{ sufferer.name }}
Surname {{ sufferer.surname }}
ID code {{ sufferer.code }}
Phone number {{ sufferer.phoneNumber }}
Email {{ sufferer.email }}
Accident description
Required
Date not valid
Date can not be in the future
Check the date
Correct time format is: 12:15
Time can not be in the future
Description of the accident
{{ model.accidentDescription != undefined ? model.accidentDescription.length : 0 }} / 1000
Required
Injury/illness/damages description
{{ model.injuryDescription != undefined ? model.injuryDescription.length : 0 }} / 1000
Required
Location of the accident
Date and time of the accident {{model.accidentDate | hkDate }} {{model.accidentTime | hkTime }}
Description of the accident
{{ model.accidentDescription }}
Injury/illness/damages description
{{ model.injuryDescription }}
Location of the accident
Country {{ model.accidentLocation.country }}
{{ model.accidentLocation.address.formattedAddress }}
Location description
{{ model.accidentLocation.description }}
Compensation
I request the compensation
Required
Required
Required
Required
Required
Required
Account number is not correct
Required
Required
Name {{ model.compensation.recipient.name }}
Surname {{ model.compensation.recipient.surname }}
ID code {{ model.compensation.recipient.code }}
Name {{ model.compensation.recipient.name }}
Company reg. code {{ model.compensation.recipient.code }}
Bank {{ model.compensation.bankName }}
Account number (IBAN) {{ model.compensation.bankAccountNumber }}
Additional information
Additional information {{ fileUploadProperties.pendingFilesCount + fileUploadProperties.uploadedFilesCount }} / {{ fileUploadProperties.maxFilesCount }}
File count limit reached. Some files has not been uploaded.
×
{{ file.size | hkFileSize }}
{{ file.error }}
Drop files here or click to upload
{{file.name}}
Privacy notice
If Insurance collects and processes personal data submitted with the claim and through the claims handling process according to the Privacy policy among other things: 1. to handle the claim and decide on the insurance indemnity; 2. to request information about the claim event (incl information concerning the state of health) from state and local government and other persons; 3. to contact you.
Advantages:
- Ninety percent of our clients evaluate our claims handling process as ‘good’ or ‘very good’.
- In case of questions call us 24/7 by phone +372 777 1211.