Informer* Policy holder/Employer Phone Email* Damage Location / Address Date of Damage Description of the event Vehicle Name of your driver Personal identification number of the driver Home address of your driver Your driver's email address* Own vehicle registration no Is the vehicle subject to VAT deduction? * -- Select -- Yes No Was anyone involved in the injury under the influence of alcohol or other drugs? * -- Select -- Yes No Did the driver have a driving license? * -- Select -- Yes No Counterparty vehicle or other property which is damaged The name of the other party driver or owner of the property Counterparty driver or the property owner's e-mail address Counterparty driver's phone number CCP vehicle Reg Other Who do you think is to blame for the injury? Description of the event Please select your broker* -- Select -- Rewenda / Suunta Meklarit Semita MSR Finser Söderberg & Partners International Insurance Finnrisk Benefit Advisors I’m not sure/other Additional information Upload attachments for your claim Drop files here to upload Data may be disclosed, inter alia, within our group, to insurance companies, pension institutions, social insurance institutions, health care providers, client entities and the subject individual for the fulfilment of our contractual obligations or in order to handle the matter in question; and to competent authorities in statutory situations. Data will be saved only as long as our contractual obligations to the client or our statutory obligations so require. We may, for example, save correspondence until the time frame to make a claim has expired. Unnecessary and outdated data will be erased, also at other times when deemed necessary or required by law or statutory regulations. You can opt out at any time by processing your information by emailing info.finland@soderbergpartners.com. I accept that client data and personal data is managed in the Söderberg & Partners group in the above mentioned manner. Submit
