I/we are *
Insurance division *
Insurance line Notes
Deductible in EUR
Insurance *
Person in charge Last name, first name *
Street and house number
ZIP CODE *
Location *
Phone number *
e-mail *
Last name. First name *
Street and house number *
Entitlement to deduct input tax
Surname, first name
ZIP CODE
Location
Phone number
e-mail
Appraisal
Visiting address
Other address
Claim number *
Date of damage *
Damage report *
Other notes
Components
Number and material of the damaged item
Glass
Glass Art
Floor covering
Living space
Kitchen
Sanitary
Miscellaneous
File upload / attachments
I hereby consent to my data being used in accordance with the privacy policy. *
* Mandatory fields
We shall send the prepared documents with our invoice in accordance with the valid price list exclusively to the above-mentioned e-mail address of the client.
