Compensa

1
Insured person
2
Event
3
Reimbursement
4
Confirmation

Claim reporter

Name

Last name

Identity number

E-mail

Phone

Insurance policy

Date and time of the accident

Insurance policy

The policy number is known

yes no

Policy number

Policyholder

Individual Legal person

First name

Last name

Identity number

Legal name

Registration number

Insured person

Insured person

Identity number

First name

Last name