Claims registration - Theft/burglary

Verlingue Switzerland

Claims registration

Please complete your damage report

Theft/burglary

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*

What was stolen? (If available, please attach proof of purchase)

Is there evidence of a break-in? / What was damaged?

Estimated amount of damage in CHF

Police report

Has a police report been made? YesNo

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)

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