Report damage

Location*

You have the ability to upload photos and documents during the claim report.

Damage date*

Do you own the property?*

Yes

No

Is the address where the damage occurred different from your residential address?*

Yes

No

Address different*

street + house number different House number addition different Residence different Postal code deviate

Is there damage to audiovisual equipment or mobile electronics?*

Yes

No

What kind of damage do you want to report?*

Residential property damage

Property damage

Both

What kind of damage do you want to report?*

Tenant interest damage

Property damage

Both

Please describe as clearly as possible how the damage occurred.*

Where did the damage occur?*

Within my home

Outside my home

Home insurance

Are you the tenant of the property? Then you can also report here improvements you have made to the property in accordance with Tenant Interest.

When you rent a property, you may make improvements to the house yourself. Consider, for example, a new bathroom, kitchen, new parquet floor and/or painting/hanging. These types of improvements are called tenant's interest. Tenant's interest also includes the above-mentioned improvements that you took over from the previous tenant against payment.

Type of damage*

Water damage

Storm damage

Fire damage

Glass/Windows breakage

Burglary damage

Other

Please describe as clearly as possible how the damage occurred.*

You should report it to the police

Contents insurance

Type of damage*

Water damage

Storm damage

Fire and/or scorch damage

Glass/Window breakage

Burglary, theft and/or burglary

Other

Please describe as clearly as possible how the damage occurred.*

You should report it to the Police.

Description of damage. Please indicate here what exactly was damaged.*

Costs incurred or estimated

Home insurance

Are you the tenant of the property? Then you can also report here improvements you have made to the property in accordance with Tenant Interest.

When you rent a property, you may make improvements to the house yourself. Consider, for example, a new bathroom, kitchen, new parquet floor and/or painting/hanging. These types of improvements are called tenant's interest. Tenant's interest also includes the above-mentioned improvements that you took over from the previous tenant against payment.

Type of damage*

Water damage

Storm damage

Fire damage

Glass/Window breakage

Burglary damage

Other

Please describe as clearly as possible how the damage occurred.*

Description of damage. Please indicate here what exactly was damaged.*

Costs incurred or estimated.

You should report it to the Police.

Contents insurance

Type of damage*

Water damage

Storm damage

Fire and/or scorch damage

Glass/Window breakage

Burglary, theft

Other

Please describe as clearly as possible how the damage occurred.*

Description of damage. Please indicate here what exactly was damaged.*

Costs incurred or estimated.

You should report it to the Police.

Name

Initials Surname

Address*

E-mail address*

Telephone*

IBAN Number*

Policy number

File

Max. file size: 30 MB.

Signature*

I certify: That the information I have entered above is true and correct. And that I have not concealed any details about this claim. That I am providing this claim form and any additional information for the purpose of determining the extent of the claim and entitlement to benefits. That information about my claim and insurance history may be requested from other insurers or advisors.

Yes

No

Completion and agreement

Principles: When reporting a claim, you are required to answer the questions on the form as completely and truthfully as possible. This also applies to questions asked of which you believe the answers are (already) known to insurers. Questions asked regarding other interested parties. If you do not, not fully or incorrectly answer the questions, you run the risk of having your right to benefits restricted or even cancelled altogether. In addition, in some cases, insurers have the right to cancel the insurance. The general terms and conditions of your insurance apply to the claim. When reporting a claim, personal data and any other details are requested. What do we do with your personal data? We register the details of this damage and your personal data with the Stichting CIS (Central Information System of Insurance Companies operating in the Netherlands). it does not matter whether the damage was caused by your fault. We register your claim(s) even if you are not insured for the claim event or if no compensation has been paid. We do this to manage risks and prevent fraud. More information and the privacy policy can be found at www.stichtingcis.nl. If permitted by law, we may share the information needed to provide services with your advisor. In addition, we engage other companies to perform services for us related to the insurance contract, for example, an expertise agency. We make arrangements with these parties to safeguard your privacy. We remain responsible for processing your data. If we process information about your health or your criminal past, we comply with the rules that apply in this respect. In some cases we may need your permission to do so.

Report damage

You have the ability to upload photos and documents during the claim report.

Home insurance

You should report it to the police

Contents insurance

You should report it to the Police.

Home insurance

You should report it to the Police.

Contents insurance

You should report it to the Police.

Completion and agreement

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