Liability claim
Claim application
Report a claim | Liability insurance | If Insurance
Who is reporting?
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Only latin characters allowed
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Only latin characters allowed
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Required
Check the phone number
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Check the e-mail address
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Claim applicant
Required
Required
Required
Required
Check the phone number
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Check the e-mail address
Required
Property owner
Required
Required
Name {{ model.submitter.name }}
Surname {{ model.submitter.surname }}
ID code {{ model.submitter.code }}
Phone number {{ model.submitter.phoneNumber }}
Email {{ model.submitter.email }}
Name {{ model.submitter.name }}
Company reg. code {{ model.submitter.code }}
Claim applicant
Name {{ model.submitter.contact.name }}
Surname {{ model.submitter.contact.surname }}
ID code {{ model.submitter.contact.code }}
Phone number {{ model.submitter.contact.phoneNumber }}
Email {{ model.submitter.contact.email }}
You are the owner? Yes No
Property owner {{ model.ownerUnknown }}
Name {{ model.owner.name }}
Surname {{ model.owner.surname }}
What happened?
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
Required
Information about offender
{{ model.offenderData != undefined ? model.offenderData.length : 0 }} / 100
Required
Location of the accident
Date and time of the accident {{model.accidentDate | hkDate }} {{model.accidentTime | hkTime }}
Description of the accident
{{ model.accidentDescription }}
Information about offender
{{ model.offenderData }}
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
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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 comments
Additional information {{ fileUploadProperties.pendingFilesCount + fileUploadProperties.uploadedFilesCount }} / {{ fileUploadProperties.maxFilesCount }}
File count limit reached. Some files has not been uploaded.
×
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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. handle the claim and decide on the insurance indemnity; 2. to request information about the claim event from state and local government and other persons; 3. to contact you.
Advantages:
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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.