Claims registration - Other damage - Verlingue Switzerland

Claims registration

Please complete your damage report

Other damage (property, buildings, IT, machinery, construction, etc.)

Responsible person

Company

Surname*

First name*

Telephone number*

Email*

IBAN or PC number

Subject to VAT YesNo

Claims data

Date of damage*

Location of damage (address)*

How did the damage occur*

Estimated amount of damage in CHF

What was damaged?

In the case of machinery/plant/IT equipment: Type and age?

In the case of building damage: Age of the building, owner of the building (if not policyholder)

Name of the injured party (if not the policyholder)

Has business been interrupted as a result of the claim?

Damage caused by a third party?

Notes on property damage

Police report

Has a police report been made? YesNo

If yes: Police station, date of report and officer in charge

Miscellaneous

Remarks

Documents

Add enclosures to the notice of claim here (max. 5 MB per file)