Letfinans - AIG (PRD)

Claim Type
ref_country
claim_language
incident_date

DayMonthYear
What type of claim do you wish to submit?*
claim_type

Claimant information

Please provide us the following details about the claimant
claimant_entityType*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Country codePhone Number
Birthdate*

DayMonthYear
Policy number*
You have received your policy number in your "Welcome email". This is a number starting with "P-LETDK" followed by 7 digits.
ID number*
Address of the Claimant
Address street*
Street number*
Postal code*
City*
Country*
claimant_address_country

Involuntary loss of employment
When were you hired?*

DayMonthYear
Do you work full time?*

YesNo
How many hours a week?*
When were you notified about the termination of employment?*

DayMonthYear
When did the terms of employment come to an end?*

DayMonthYear
What was the reason for the terms of employment ending?*
What type of employment did you have?*
Country of employment?*
Are you self-employed?*

YesNo
Please upload the necessary documents
Employment contract*

Cancelof
Document confirming the termination with reason and date*

Cancelof
Document confirming that you are fully entitled to unemployment benefits*

Cancelof
Document confirming payment of unemployment benefits*

Cancelof

Death
Name of the representative of the deceased's estate*
Full Name
Email of the representative of the deceased's estate*
example@example.com
Phone number of the representative of the deceased's estate*

Country codePhone Number
Date of death*

DayMonthYear
Street*
Street number*
Postal code*
City*
Country of death?*
Cause of death
Death caused by an ...*

AccidentIllness
Accident
When did the accident take place?*

DayMonthYear
How did the accident happened?*
Where did the accident take place?
Street*
Street number*
Postal code*
City*
Illness
When did the illness occurred?*

DayMonthYear
Which symptoms / diagnosis?*
Please upload the necessary documents
Death certificate*

Cancelof
Document showing cause of death*

Cancelof
Police report in case of accident etc.*

Cancelof
Medical report from a hospital or other health authority*

Cancelof
Power of attorney to represent the estate*

Cancelof
Certificate from the probate court*

Cancelof

Bank details
Registration number*
Account number*

Consent to the processing of sensitive personal data.
I provide my explicit consent to the processing of the personal data, including special categories of personal data, I submitted in this claim form. In connection with this claim, I authorise AIG to obtain any information that AIG may deem necessary for the processing of the case, e.g. from doctors, health services, authorities or persons who process information about me or my health conditions.
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.
By providing your personal information to AIG in connection with your claim, you consent to the collection and processing of your personal information as described in the Personal Information Use Policy available at www.aig.com/privacy-policy or upon request. Furthermore, You consent to the Policyholder confirming to AIG that You are indeed covered under the Policy. To the extent that you have provided (or will provide) personal information to AIG about third parties, you confirm that you have informed the third party of the contents of AIG's Personal Information Use Policy and you are authorized to disclose the third party's personal information to AIG as described in the Personal Information Use Policy.

Moreover, Qover, who is an independent data controller, will collect and process your personal data in connection with you reporting a claim through the insurance. You can find more information about how Qover processes your personal data by vising their Privacy Policy.
Should be Empty:

Claim Type

Claimant information

Address of the Claimant

Involuntary loss of employment

Please upload the necessary documents

Death

Cause of death

Accident

Where did the accident take place?

Illness

Please upload the necessary documents

Temporary disability, critical illness and cancer

Accident

Where did the accident take place?

Illness

Treatment

Please upload the necessary documents

Bank details

Consent to the processing of sensitive personal data.