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New claim
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New claim
__Claim report GAP
Data of GAP policy
Vehicle data
Data of Basic Insurance Company (Motor Insurance/Third Party Insurance)
Claim data /breakdown data
Attachment – copy of the document (-s)
Claimant (Data of the Insured)
Data of GAP policy
Policy number
VIN number
Personal ID Number/Taxpayer identification number
Find the policy
Insurance inception date
Insurance expiry date
Vehicle data
Registration number
Make
Model
Data of Basic Insurance Company (Motor Insurance/Third Party Insurance)
Name
Number of Repair Cost Insurance policy
The value of the vehicle on a day of claim occurence
Currency
PLN
EUR
GBP
BGN
HRK
CZK
RON
HUF
Date of decision from the Basic Insurance Company
Date of payment made under Repair Cost Insurance
Contact to Claim Handler
Claim data /breakdown data
Date of claim occurence
Mileage in KM
Claim circumstances
Attachment – copy of the document (-s)
Decision on compensation payment made by Basic Insurance Company *
Attach:
Document confirming that total loss has been settled *
Attach:
Vehicle purchase invoice *
Attach:
Registration card of the vehicle *
Attach:
Document confirming the conclusion of GAP policy *
Attach:
Repair Cost Insurance policy indicating the insurance amount and insurance period *
Attach:
Document confirming that the compensation has been made under Basic Insurance Company *
Attach:
Decision on discontinuation of the action reagrding vehicle theft
Attach:
Document confirming that leasing/credit agreement has been settled
Attach:
Other attachments
Attach:
Claimant (Data of the Insured)
Name
Surname
Company name
Street name
Building number
Apartment number (optional)
Post code
City
Telephone
E-mail
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