Purchase insurance claims form

Information about you

Name, Surname

Personal code

Phone number

E-mail

Information about the accident

What happened?

Accident date

Accident place (address)

Have you informed the police about the accident?

Yes

Accident photos and purchase confirmation documents

Please provide your bank account number for claims payout

Bank account number

I certify that the information provided in this application is true and accurate. I understand that providing false or misleading information may result in If P&C Insurance AS Latvian branch withholding insurance compensation and I may be subject to criminal liability for fraud under Article 177 and Article 178 of the Latvian Criminal Law.

Yes, I certify

P&C Insurance AS Latvia branch will use the information you provide about yourself and the accident in accordance with Privacy notice to:

evaluate your claim and make a decision on the compensation;
exchange information with state registers as required by regulatory acts;
contact you.

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