ACCIDENT INSURANCE

Notification of the event

EVENT INFORMATION

Accident or diagnosis of an illness
Event circumstances*

INFORMATION ABOUT INSURED (injured) PERSON

IN CASE OF THE INSURED EVENT, PLEASE TRANSFER THE INSURANCE BENEFIT TO

SUPPORTING DOCUMENTS

The size of a single attached document should not exceed 5 MB, and the maximum size of all documents should not exceed 30 MB. Allowed file types: .pdf, .jpg, .doc, .xls, .rar, .zip, .7z, .bmp, .png.

Attach documents (medical statement, documents confirming the expenses, certificate of incapacity for work, etc.)

DETAILS OF THE NOTIFIER

Read the Information Clause before submitting the form.