Submit your claim details

Country *

Accommodation Agency First Name * Surname * Date of Birth (DD-MM-YYYY) * Email * Telephone number (with country code) Full Address

Do you have any other insurance? *

If yes, please provide details (max 10,000 characters)

Booking ID * Trip Destination Country *

Trip Destination City * Booking Date (DD-MM-YYYY) * Arrival Date (DD-MM-YYYY) * Departure Date (DD-MM-YYYY) * Account Holder Name (as per bank) * Bank Name * Bank Country *

Account Number Sort Code IBAN Swift Code Incident Date (DD-MM-YYYY) * Claim Amount In EUR * Please describe what happened: (max 10,000 characters) *

I am happy to participate in a survey regarding my claims experience.

Declaration: I agree and I hereby declare that all the information and documents I have provided to support this claim are true and correct to the best of my knowledge and belief. I have not knowingly withheld any information relevant to this claim which would affect the true and fair assessment . I will retain all supporting claim documentation for at least 30 working days (excluding weekends and bank holidays) after the claim has been finalised as it may be requested for audit purposes.

Claims Form

Details

Personal Details

Booking Details

Bank Details

Incident Details