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Home
Claims
Complaints
Finance
About us
Contact
EN
French
German
Austrian
Spanish
Italian
Romanian
Portuguese
Complaints
Form
For detailed information about the Complaints process, click
here
.
Personal Data
Name
*
Name
Surname
3rd Party (Next of kin, Sibling, Spouse, Legal Representative)
I am not the insured
Relation
Please select
Next of Kin
Sibling
Spouse
Legal Representative
Phone Number
*
Address
*
Email Address
*
Preferred Method of Contact
*
Email
Phone
Preferred Contact Time
*
Morning
Afternoon
Insurance / Contract Ref Number
Insured’s Date of Birth
*
Day
1
2
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31
Month
1
2
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12
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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2003
2002
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender
Please select
Other
Male
Female
Specify your Complaint
Terms and Conditions
*
I have read and accept the
Terms and Conditions
