Claim form

reply-to-email
Welcome to your claim form

We are very sorry you were involved in an accident. Please fill out the form below and we will assist you with your claim.

In case of emergency, please reach out to the roadside assistance provider:
- For contracts in Belgium +32 2 320 39 75.
- For contracts in Spain +34 900 431 710.
- For contracts in Austria +43 800 007018.
- For contracts in France: +33 9 71 07 28 38.
- For contracts in Germany: +49 800 0009619.
- For contracts in the Netherlands: +31 800 0200362.
- For contracts in Portugal: +351 800 181 521.
- For contracts in Denmark: + 45 89 87 06 42.
- For contracts in The Republic of Ireland: +353 91 56 0636
Please make sure you have the following documents at hand
(you will be required to upload them later on):
- European Accident Form (if available)(not applicable for the Republic of Ireland)
- Pictures of damaged car(s)
refsCountry
partnerName
carBrand
claim_type
tpa_name
claimLanguage

Your personal information

Please provide us the following details
Driver's name*

First NameLast Name
Driver's date of birth*

DayMonthYear
Date
Country*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Policyholder details
Policy reference*
The reference mentionned on your vehicle's insurance certificate or 'green card'.
Is the policyholder different from the driver? *
entityType
Policyholder's first name *

First NameLast Name
Company's name*
Company number*
Vehicle registration plate number*
Driving licence type*
How many kilometres/miles are on your vehicle’s odometer?*

Accident information

Please provide us with the following
When did the accident take place?*

DayMonthYear
Date
Hour Minutes
City of the accident location*
Street and number of the accident location*
Short explanation of the incident*
Is there a third party involved?*

YesNo
Third party first and last name*

First NameLast Name
Third party phone Number

Area CodePhone Number
Third party Vehicle Registration Number
How many people were in the third party's car?
Have any injuries been reported?

YesNo
Who is injured and what is the nature of the alleged injury? Mention whether an ambulance or the fire brigade arrived on the scene.
Is there any other damaged property (other than vehicles)?

YesNo
Please describe the nature of the damage and give the name of the owner of the damaged property (if known).
A third party holds you liable (another person asks you for compensation)
thirdPartyInvolved
Was the incident reported to the police?*
Please provide the police reference*
Was the driver under the influence of drugs, medicines, or alcohol?*

Documents
Please upload the European Accident Form (if available)

In case of a traffic accident, you must fill in one accident report with the other people involved in the accident.
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Please upload pictures of damages

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Please upload the police report

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Please upload a copy of the driver's licence

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Please upload any other relevant documents

All documents describing the accident such as : police report, accident report, witness report,...
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Feel free to add any other relevant information

Fair Processing Notice
Information about data protection and your privacy rights
Your personal data will be collected and processed by Qover SA (“Qover”) that is the controller of the personal data you provide us when you submit your claim. If you have provided information about a third party, you should show this Notice to them and you are responsible to have legally obtained their consent to act on their behalf and share their personal data. Your data will be processed only for specific purposes such as risk assessment, insurance contract management, claims handling, customer care support and crime prevention (such as fraud), as well as to allow Qover to fulfil its legal obligations. We only collect and process sensitive personal data where it is critical for the provision of our Services and without which the Service cannot be provided. Qover may disclose your personal data to third parties, such as the risk carrier, claims handler, service providers, sub-processors, other partners and authorities, for the same purposes. Personal data may be transferred abroad. Such transfers are subject to appropriate safeguards, including an adequacy decision or contractual safeguards, in accordance with the applicable legislation. Also, you may have the following rights relating to your personal data and in particular the rights of access, rectification, erasure or restriction of processing or to object to processing as well as the right to data portability. To exercise these rights, you may contact at any time by writing Qover’s DPO at privacy@qover.com.

For more information about how we process your personal data, please see our Privacy Policy and the Fair Processing Notice.
Generali Seguros y Reaseguros S.A.U., trading in Ireland as RedClick, is the Data Controller of your personal data for the purpose of handling the insurance claim. Your data will be shared with our claims’ services providers which, for this purpose, includes Qover S.A./N.V., as well as with the National Insurers Association to check claims' historical information and for fraud prevention. For complete information on the data processing carried out, please consult the Privacy Notice available at www.redclick.ie/privacy-policy-and-general-data-protection-regulation and www.qover.com/terms-and-policies. For any query or to exercise your right of access, rectification and deletion of personal data, among others, please send an e-mail to privacy@qover.com.
I provide my explicit consent to the processing of the personal data, including special categories of personal data, I submitted in this claim form.*

Yes, I agree
I have read and agree to the information provided in Redclick Privacy Policy and Qover Privacy Policy (see links above).*

Yes, I agree.
I have answered the questions to the best of my knowledge, accurately, and truthfully and have not concealed any information related to this claim. I am aware of the stipulation that any right to benefit may lapse with an untrue statement.*

Yes, I agree.
By submitting this form, you provide us with your explicit consent to process your personal data, including your sensitive personal data, for the above purposes, including handling your claim.*

Yes, I agree.
Should be Empty:

Your personal information

Policyholder details

Accident information

Documents

Fair Processing Notice

Information about data protection and your privacy rights