Please fill out your claim form

Claim forms

Other damage

Surname(Required)

First name(Required)

Company(Required)

Telephone number(Required)

Email(Required)

IBAN or PC number

Subject to VAT

Yes

Date of damage or when a problem was first detected(Required)(Required)

Location of damage(Required)

How did the damage occur(Required)

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

Has a police report been made?

Yes

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

Remark

Drop files here or

Max. file size: 5 MB, Max. files: 5.

(You can add up to five attachments here. You are welcome to submit any additional documents to schaden@verlingue.ch.)