First Notice of Loss Form

First Notice of Loss Form

Important: In case of Top Urgency, please call + 31 10 420 8200. Otherwise, please fill out below form as a first notification of your claim.
Please do not wait with sending this form until all information is complete. Your name, address and other data will be treated in compliance with the General Data Protection Regulation (GDPR).

At the bottom of the form, you can see in green fonts, which documents we request you to upload (if available).
Fields marked with an asterix (*) are mandatory.










in case of more types of damages, take the most important one












If available, please upload copies of:
Upload of document(s) and/or picture(s), max 20 MB