Device insurance and extended warranty insurance claim notice

Notifier details

First name

Last name

Personal identification code issuer

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Insured event

Policy / Certificate Number

Item name, manufacturer, model

Purchase date

Purchase price

Damage was caused by

Event date

Error occurrence date

Country

Venue additional information

Please add information about the location as accurately as you know

Describe the event and damages

0/1000

Error’s description

0/1000

Police was notified

Yes

Notification date

Additional information and confirmations

Location of device

Name and location of the company

The address of device location

Description of device location

Other informed persons

Name and location of the company

Additional information

0/1000

I confirm the accuracy of the above data and agree to the processing of my personal data by LHV Kindlustus in accordance with the principles of LHV customer data processing.

I know that if I knowingly submit wrong data, then insurer has the right to decrease compensation or refuse to pay compensation completely.

I agree that insurer has the right to request additional information concerning the claim from persons that possess it.