Card purchase insurance claim notice

Notifier details

First name

Last name

Country of residence

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Bank card details

Card type

The last four digits of the card

****

I am cardholder

Yes

Your relationship with the cardholder

First name

Last name

Country of residence

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Insured event

Item name, manufacturer, model

Purchase date

Purchase price

Damage was caused by

Event date

Country

Venue additional information

Please add information about the location as accurately as you know

Describe the event and damages

0/1000

Police was notified

Yes

Notification date

Additional information and confirmations

Additional information

0/1000

I confirm the accuracy of the above data and agree to the processing of my personal data by LHV Kindlustus in accordance with the principles of LHV customer data processing.

I know that if I knowingly submit wrong data, then insurer has the right to decrease compensation or refuse to pay compensation completely.

I agree that insurer has the right to request additional information concerning the claim from persons that possess it.

Card purchase insurance claim notice

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