Report damage request refund

First Name

Last Name

E-mail Address

Phone Number (optional)

Your policy number (Polizzennummer) - (starting with 700.........)

Bank Details:

Please enter your personal European bank account.

The refund will be transferred to this account

Bank Name

IBAN Code

BIC Code

Text (please very briefly describe what the refund is for)

Important:

To be able to process the claim you need to upload the diagnosis from the doctor and the actual bill.
In case you did not get a diagnosis please get in touch with your doctor for it!

Upload Files

Report Damage / Request Refund

Bank Details: