Pet claim notice Details of the person reporting the event First name of the person reporting * Last name of the person reporting * Personal ID code * E-mail address * Mobile number * The person reporting is the policyholder * Yes No Policyholder information The name of the policyholder * Personal ID code or registry code * Policy number Loss event data Date when event occurred * If the exact date is unknown, enter the date of detection of damage. Time of the event Location where event occurred Street * House number or farm name * City or village * Consequence of the incident * Choose ... Medical treatment of a pet Death of a pet Loss of a pet Another person’s property or health Please specify to who and why damage was caused* Pet chip number* Event description * Describe, in detail, the reasons, events and consequences of the insured event Has a similar insurance contract been concluded with another company? * Yes No Don't know Please specify* Has a claim for damages been made against another insurance company in the same case or has another insurance company already compensated the damage? * Yes No Don't know Please specify* File upload (total maximum 30Mb) File upload Please attach existing documents related to the case. For example, the pet's medical history (with diagnosis) and documents proving the cost of treatment or other documents relating to the case. – Remove file + Add more files Indemnity I request an indemnity for the incurred damages * Yes No Estimated damage in euros Name of beneficiary Bank account number *I hereby confirm that all data above is right and complete. I know that if I knowingly submit wrong data, then insurer has the right to decrease compensation or refuse to pay compensation completely. I agree that insurer has the right to request additional information concerning the claim from persons that possess it. Your claim report is sent to ERGO claims' processing department. The notice will be forwarded to the claims handler. We hereby inform you that the time required for making decision is up to 10 working days following the receipt of all necessary documents and information. If necessary, we will contact you before making a decision. In case of additional questions please contact us at email@example.com. There was an error during data sending. We are sorry. There was an error during data transfer. Please send your request directly to the email firstname.lastname@example.org.