Travel claim notice

Notifier details

First name

Last name

Country of residence

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Insurance contract

Type of insurance contract

Policy number

Card type

****

I am cardholder

Yes

Your relationship with the cardholder

First name

Last name

Country of residence

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Sufferers

I am a sufferer

Yes

Sufferer's details

Your relationship with the injured party

First name

Last name

Country of residence

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Add more sufferers

Insured event

Start of the trip

Travel itinerary

Please add all transfers and destinations

0/1000

Event date

Time

Country where the event occured

Venue additional information

Describe the place of the event (town, region)

0/1000

Why and how did the event occur?

0/1000

Was the event reported to the travel agency, to the transport company, to the police or other institution?

Yes

Institution

0/500

Notification date

Contact details

0/1000

Loss event data

Type of damage

Description of the injury/illnesses

0/1000

Description of damage

0/1000

Healthcare provider's name

0/1000

Is the treatment over?

Yes

Description of damages/expenses

0/1000

Add information about other types of damages

Additional information and confirmations

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.

Travel claim notice

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