NOTIFIER DATA: First name and surname of the notifier: * Personal identification code of the insured person: * Telephone: * E-mail: * DESCRIPTION OF LOSS EVENT: Select the type of insurance: * - Select -Traffic damageTravel lossVehicle loss (kasko)Accident insurance lossesLiability insurance lossProperty damageOther Policy number: * Date of loss event: * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year201820192020 Time of loss event: * Hour Hour01234567891011121314151617181920212223 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 Description of loss event: * CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
