Informer* Policy holder/Employer Phone Email* Damage Location / Address Date of Damage Description of the event Planned start date of the trip Planned end date of the trip If your trip has been canceled: Travel booking date Trip cancellation date Has it been possible to obtain reimbursement from the tour operator or travel agency for the costs of the cancellation? -- Select -- Yes No Injured person Name Security ID* Home address* Account number Have the costs already been incurred? -- Select -- Yes No Please provide the sum of the costs of the transaction Has the injured person been covered for the costs he / she has incurred? -- Select -- Yes No When did the symptoms of illness or accident begin? Have a doctor been visited? -- Select -- Yes No When did you first see a doctor for an incident? 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 You can attach several files by pressing the ctrl key 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 Unnecessary and outdated data will be erased, also at other times when deemed necessary or required by law or statutory regulations.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
