Customer service

Self-service
CLAIMING DAMAGE

Do you have damage to claim? Please fill in the form below as fully as possible and we will do our best to process your claim as quickly as we can. Please include relevant photos and a sketch of the situation when you submit your claim. When you have submitted the completed form, you will receive confirmation of receipt and we will inform you of the status of your claim.

Fields marked with * are mandatory.

 

 

Contact details

Name is required
E-mail is required
Enter a valid e-mail address
Phone is required
Enter a valid phone number. Permitted characters are numbers (0-9), spaces and plus and minus signs.
Street is required
House number is required
Postcode is required
Enter a valid Belgian postcode.
Town/city is required
Country is required

Location and date

City is required
Facility is required
Enter the date and time of the incident.

Details

Description of the cause and circumstances of the damage.
Circumstances is required
Please provide the identity of any witnesses, including address.
Witnesses is required

Attachments

Drop here or browse
Uploads
Saved documents

Damage

Material damage

Description of the material damage.
Description is required
Is the person submitting the claim also the user of the damaged items?
Are the damaged goods insured?
The insurance company that insures the items.
Insurance company is required

Personal injury

Please describe the personal injuries/wounds.
Description is required
Occupation is required
Age is required

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