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Property insurance

Notification of the event

EVENT INFORMATION

Event date*

Event time

Event country*

Event address ( address, city)*

Event circumstances*

Write text here…

Was damage caused to others persons property?*

INFORMATION ABOUT POLICYHOLDER

Policyholder is private person

Policyholder is legal person

Personal ID or Insurance policy number*

Name*

Surname*

Company code or Insurance policy number*

Company name*

E-mail*

Phone number*

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

Beneficiary is the policy holder

Personal ID/Company code

Name Surname/Company name

Bank account

SUPPORTING DOCUMENTS

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

Attach documents (photo of damages, property ownership document etc.)

Attach documents

This doesnt matter

Attach documents

DETAILS OF THE NOTIFIER

Notifier is the policy holder

Personal identification number*

Name*

Surname*

Address*

Phone number*

E-mail*

Read the Information Clause before submitting the form.

Select all

I agree that Balcia Insurance SE, acting through Poland branch, and its authorized third parties process my personal data related with health condition for the purposes of handling my claim application and calculating and paying insurance indemnity.

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Information Clause Privacy Policy Self service regulations