Claims report - NVC AG Basel Switzerland

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Claims report

Claims report

Addressing
First name*
Last name*
Company*
Street + No*
Postcode*
City*
Telephone number
Mobile phone*
E-Mail*
Policy number*
Industry
Cause of claim
Date of claim*

DAY
MONTH
YEAR
Place of claim*
Cause of claim*
Amount of claim (estimated)*
Injured party (who was injured or what was injured)
Party causing the claim (who caused the claim, name, address, tel.)
Notification is made? (Details of the police, contact person, address, telephone)
Enclosures
Drop files here or

Accepted file types: jpg, docx, png, pdf, Max. file size: 512 MB, Max. files: 10.
Damage pictures, accident report etc.

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