Private liability insurance claim report | Claim Pro Insurance Broker

Insurer name *

Insurance contract no. *

Full name of the policyholder *

Email *

Please fill it out accurately so we can follow up with you about your claim and request additional documentation.

Date and time of the insurance incident *

Datum

Zeit

The location or address of the incident *

Other party information (full name, address, and phone number) *

Tenant liability insurance claim case (landlord's name, address, and phone number)

The other party's relationship with the policyholder *

Damaged product information *

e.g. brand name, model name, item number, etc.

Current value calculation (purchase date, purchase cost) *

Required if breakage or damage has occurred to the property of the third party.

Attach photos of the damage *

Klicke oder ziehe Dateien in diesen Bereich zum Hochladen. Du kannst bis zu 10 Dateien hochladen.

Please attach multi-angle photos so that the insurance company can clearly see the extent of the damage. If the resolution of the photo is too high, we may have difficulty delivering the file, so please set it to a reasonable size before taking the photos.

Attach past purchase/installation receipts

Klicke oder ziehe Dateien in diesen Bereich zum Hochladen. Du kannst bis zu 5 Dateien hochladen.

Attach the previous purchase receipt from the owner of the damaged product

Attach an inspection report or estimated repair cost *

Klicke oder ziehe Dateien in diesen Bereich zum Hochladen. Du kannst bis zu 5 Dateien hochladen.

The insurer has the right to verify and determine the appropriateness of the repair costs (overcharging/identification of liability) during the claims process. Please do not proceed with the repair or replacement in advance.

Statement of incident *

For the protection of the policyholder, please provide a detailed description of the incident. We will handle the claim process on your behalf to avoid any statements that could be used against you.

Data use agreement and permission *

I consent to having Sicher Sicher GmbH store and use my submitted information and documents so they can proceed with my claim process.