Annullierungskostenversicherung vor Antritt der Reise

Notification of claim

Cancellation Insurance Prior to Departure

Unfortunately you had to cancel your journey. In order for us to be able to provide an insurance benefit quickly and easily, we require several important details from you. Having the documents listed below ready will make the process of reporting the claim easier for you.

Note: In case of illness/injury the medical certificate must be filled out by the attending physician in advance for a claims amount of CHF 2'000.- or more.

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Travel documents (booking confirmation and cancellation bill along with the organisers terms)
Medical certificate / Death certificate / other confirmation
Medical Questionary (for an amount of CHF 2'000.-- or more)
Insurance policy/card (copy)

Note: Please upload the document.

Notification of claim

Questions concerning the policyholder (eligible person)

Name

First name

Date of birth

Street

No.

Postcode

Place

Phone (day time)

E-mail

Account Number (IBAN)

Bank Code (BIC/SWIFT)

Your insurance policy/certificate no. (in case of an annual policy)

Notification of claim

Questions concerning further insurance coverages

Are you insured against cancellation fees with any other insurance company?

Company

Policy no.

Have the travel costs been payed by credit card and have those costs thus been insured by the credit card company?

Please give us the name of the credit card provider incl. card name (e.g. Gold MasterCard)

Name of the cardholder

Has compensation already been paid to or applied for by another party?

By whom:

Notification of claim

Questions concerning the planned journey

Date of booking

Date of cancellation

Date of planned departure

Number of travel participants?

How many of them cancelled?

How the travel participants relate to each other?

Cost of the trip for the person(s) covered: CHF

Cancellation costs incurred for person(s) covered: CHF

Notification of claim

Questions about the incident

Unexpected severe illness
Death
Accident
Other

Brief summary of the case

When did the incident happen?

Was a doctor consulted?

When for the first time?

Name and address of the doctor in attendance

When did the doctor advise you against the journey?

Please specify the exact diagnosis (no abbreviations)

Notification of claim

Comments

Further comments

Summary

Edit

With this click, I hereby confirm the completeness of the documents and the correctness of the information and confirm that I am aware that untrue or incomplete information may lead to the loss of the claim to insurance cover.

With this click, I authorise ERV to process data to the extent necessary in connection with the claim settlement, and, in the case of doctors, hospitals, medical personnel, private and public enterprises, authorities, the police and the fire service, private and social insurers in Switzerland and abroad, to obtain information or to access files and I release the bodies mentioned and their assistants from their official or professional secrecy or their duty of confidentiality and authorise them to provide information. In addition, I agree to communicating by unencrypted e-mail for the settlement of the claim.

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