Iberia Insurance - Versicherung und Versicherungen Mallorca, Spanien und Marbella. Gebäudeversicherung, Hausratversicherung, Krankenversicherung


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Claims Form

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Contact in Spain:

+34 971 69 90 96

All fields marked with an asterisk (*) must be completed!

Type of insurance (e.g. Building Insurance, Householders Insurance, etc.)
Insured *:
Where did the loss occur:
Date of loss:
Date loss was noted:
Date loss was first reported:

Policy Number *:
Phone*:
Address:

Do Third Parties have titles on the insured property?	Yes No
If yes, please give details:

Are you entitled to set off Value Added Taxes? Yes No

Did – in your opinion - the loss result in Third Parties having any rights to claim compensation?	Yes No
If yes, please give details:

Is the insured property insured elsewhere?	Yes No
If yes, please give details:

Amount of loss or damages:
Exact amount in EUR:
Estimated amount in EUR:
If the loss amount varies significantly from the estimate please give reasons.

Prior losses:

Have you or another person affected by the loss been previously affected by similar losses?

Yes No

If yes, please give details (Object - date of prior losses - nature and size of prior losses – were the previous losses insured?)

Please describe the exact circumstances of previous losses:

What happened? What was damaged and how? Why could previous losses occur? Please give as much detail possible.

Please provide as much evidence as possible (e.g. photos – repair estimates/invoices – loss surveys – etc.).

Mitigation:

What was done to mitigate damages?

Reimbursement

In case of payments these are to be made to:

Account holder:
Bank:
Account Number:
Bank Code:

Duties and Obligations (please read carefully)
I have been informed that I am obliged to answer all questions by the insurer truthfully and completely and to supply any information which may be relevant to the insurer. I, the insured, accept full responsibility for the information provided even if the claims form was filled out by someone else on my instructions. I am aware that supplying false or incomplete information may result in the cover becoming void.

Email:

Name:

Last update 06.07.2007