GrandOptical Belgium - File a claim

GrandOptical Belgium Claim Form
We're sorry you had an incident with your glasses. Please submit your claim in this form.
Check your eligibility
Provided that you have subscribed to the Eye Omnium insurance when you buy your glasses, we cover damage caused by:
- Scratches
- Breakage
- Loss (simple disappearance or theft)
What are the coverage exclusions?

In case of scratches, breakage and loss, the maximum contribution of the insurer is limited to 1 (one) claim during the entire membership period.

The insurance will never intervene for:
- damage caused by wear and tear;
- consequential damage and loss of any kind (e.g. personal injury caused by broken glass, etc.);
- damage caused intentionally;
- the after-sales service that your optician carries out as standard (e.g. checking the frame and lenses, checking the fit of the glasses (sunglasses) and correction if necessary, tightening, replacing and fixing screws, lubricating the hinges);
- damages paid to your optician by the manufacturer under the warranty;
- frames, if new lenses are fitted to existing frames and only these lenses are insured;
- changes in vision due to medication, pregnancy, and medical conditions that affect vision.
Do you have these documents?
We'll ask you to upload these documents later in this form. If you don't have them, we might be unable to process your claim.
Invoice or receipt of purchase

A copy of the invoice or receipt you received when purchasing your glasses.

This must include the date you purchased, the list of goods purchased and the amount charged to you.
Proof of insurance

A copy of your insurance certificate, mentioning the policy period, insured item and the insured value.
Police report (in case of theft)

A police report confirming that you reported the theft of your glasses.

If the theft occurred in Belgium, you can report the theft here.
Proof of purchase of replacement glasses (in case of loss/theft)

A copy of the invoice or receipt of the replacement glasses you purchased after the loss or theft.
Proof of repair of your glasses (in case of scratches/damage)

A copy of the invoice or receipt for the repair of your damaged glasses.
Optional: pictures of the damaged glasses

In case of damage, you can upload pictures showing to what extent your glasses have been damaged.

Insurance and incident information
Please provide your insurance policy number*
For example: M-EYE5196780-#######
I do not know the number of my insurance policy and do not have a copy of my insurance certificate.
Purchase value of the glasses (EUR)*
What incident would you like to claim for?*
claim_subtype*
insurer*
When did the incident take place?*

DayMonthYear
Where did the incident take place?*
Please describe the incident and/or cause of damage.*
Do you have another insurance covering the same item?*
Please provide the name of the insurer and the contract number*
ref_country
language

Claimant information
claimant_entityType*
Name*

First NameLast Name
Date of birth*

DayMonthYear
Email*
claimant_address_locality*
Address*

Street Address

Street Address Line 2

CityCountry

Postal / Zip CodeCountry
Bank account details

Please provide us with the account number where you would like to receive the refund if your claim is successful.
Bank account number (IBAN)*

Proof documents
Please provide the proof of purchase of the glasses*

A copy of the invoice or receipt you received when purchasing your glasses.
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Please provide the insurance certificate*

A copy of your insurance certificate, mentioning the policy period, insured item and the insured value.
Cancelof
Please provide the police report*

A police report confirming that you reported the theft of your glasses.
Cancelof
Please provide the proof of purchase of replacement glasses*

A copy of the invoice or receipt of the replacement glasses you purchased after the loss or theft.
Cancelof
Please provide proof of repair of your glasses*

A copy of the invoice or receipt for the repair of your damaged glasses.
Cancelof
Optional: Please provide pictures of the damaged glasses

In case of damage, you can upload pictures showing to what extent your glasses have been damaged.
Cancelof

Qover privacy notice
Your personal data will be collected and processed by Qover SA (hereinafter ‘Qover’) which is an independent controller responsible for the processing of the personal data you are required to share when you submit your claim.

The data will be processed only for the purpose of the use of the services provided by Qover, including risk assessment, insurance contract management, claims handling and crime prevention (such as fraud) as well as to allow Qover to fulfil its legal obligations.

Qover may disclose personal data to third parties, such as service providers, and subcontractors, or our partners such as Helvetia, for the same purposes.

Furthermore, Qover might disclose personal data to the risk carrier, Helvetia, for claims handling purposes.

Personal data may be transferred abroad, including to countries outside the European Economic Area. Such transfers are subject to appropriate safeguards, including contractual safeguards, in accordance with applicable European regulations.

The persons concerned have certain rights relating to their 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 us at any time by writing Qover’s DPO at privacy@qover.com.

For further information about how Qover processes your data please visit our Privacy Policy.
I hereby declare that:*

I provide my explicit consent to the processing of the personal data I provide in this claim submission form.I have read and agree to the information provided and Qover Privacy Policy.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.
Should be Empty:

GrandOptical Belgium Claim Form

Check your eligibility

Do you have these documents?

Insurance and incident information

Claimant information

Bank account details

Proof documents

Qover privacy notice