wau-miau Illness/Accident Report

Reimbursement of treatment costs – Illness/Accident

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.

Receipts with prescriptions from the veterinarian
Invoices including diagnosis (veterinarian, hospital)
Veterinarian's report/certificate or medical history

Note: Please upload the documents:

Drag the file here
or click to select it (10 MB; jpg, png oder pdf)*

Document accepted

Information on the submission of the invoice for your animal

We ask you to submit your collected invoices only after you have reached your deductible and/or the treatment is completed.
The limitation period is 5 years.

Your pet insurance/policy no.

wau-miau Illness/Accident Report

Questions concerning the policyholder

First name

Name

Street

No.

Postcode

Place

Country

E-mail

Phone (day time)

Account Number (IBAN)

Bank Code (BIC/SWIFT)

Name, post code and location of the bank

wau-miau Illness/Accident Report

Questions about the animal treated

Name

Animal

Sex

male
female

Breed

Colour

Date of birth

Microchip No. (if available)

wau-miau Illness/Accident Report

Details of visits to the vet

Note:

All treatments carried out/visits to the vet are to be entered separately. To enter further visits to the vet, click on the “Further treatments” button.

Treatments (vet)

Date of treatments (vet)

Symptoms, reason for treatment including diagnosis, description of the accident

Date of the first symptoms of this disease / injury

Date of the first treatment of this disease / injury

Is the treatment completed?

When is the treatment expected to be completed?

Is a third party at fault?

Please give us the name of the person causing the damage:

Name

First name

Street

No.

Postcode

Place

wau-miau Illness/Accident Report

Comments

Further comments

wau-miau Illness/Accident Report

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 veterinary surgeons, hospitals, medical personnel, private and public enterprises, authorities, the police and the fire service, 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 email for the settlement of the claim.

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wau-miau Illness/Accident Report

wau-miau Illness/Accident Report

wau-miau Illness/Accident Report

wau-miau Illness/Accident Report

Treatments (vet)

wau-miau Illness/Accident Report

wau-miau Illness/Accident Report

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