SBX - International SOS

Claim Notification
Dear customer,

Please assist us in processing your claim by answering all the questions in this claim notification carefully. Even if you do not complete the form yourself, please check whether the information entered is correct and complete before signing.

Note: To check the insured event, it is necessary to answer the following questions truthfully and completely. Insurance coverage is at risk if incorrect or incomplete information is provided. Please read in advance the separate note in the appendix to this damage report as well as the relevant provisions in the General Terms and Conditions of Insurance regarding the consequences in the event of violation of obligations and legal obligations according to the event insured in accordance with Art. 39 et seq. of the Federal Act on Insurance Contracts (VVG).
ref_country*
insurer*
do_not_send_report*
language*
fromEmail*
replyTo*
incident_date

MonthDayYear
Date
Please enter your policy number:*
Which type of claim would you like to submit?*
claim_type*

Do you have these documents?
We'll ask you to upload these documents later in this form. If you don't have them, we won't be able to finalize your claim.
Business travel insurance

Confirmation of employer that it is a business trip.
Business travel insurance

Medical diagnosis report with the discharge report of the hospital
Business travel insurance

Confirmation of employer that it is a business trip.

Medical diagnosis report with the discharge report of the hospital
Illness / accident

Medical diagnosis report with the discharge report of the hospital.
Healing costs

Documents, application forms for reimbursement, forms of health authorities,
confirmation of insurance companies
Baggage delay
- Baggage receipt check-in
- Flight ticket
- Confirmation of the duration of the delay by the responsible location (Property Irregularity Report)
- Receipts for additional expenses / purchased supplies
- Proof of compensation provided
Flight delay
- Flight tickets with boarding cards
- Proof of delay of the airline
- Receipts for additional costs/expenses
Travel delay
- Flight tickets with boarding cards
- Proof of delay of the airline
- Receipts for additional costs/expenses
Travel withdrawal, cancellation of travel or change in travel
- Flight tickets with boarding cards (copy)
- Cancellation calculation of the flight/travel company
- In case of illness/accident, medical diagnostic report with confirmation of the inability to travel
- Death certificate in case of death
- Other reasons: Receipts for the event entered
Theft
- Copy of the theft display at the responsible office (police report, etc.)
- Confirmation of the transport company (airline, etc.)
- Proof of compensation provided
Damage
- Confirmation of damage by the responsible location (property irregularity report)
- Receipts for purchase, replacement or repair
- Proof of compensation provided
Report of invertigating authority
Death certificate

Travel Health Insurance
Personal details
Name

First NameLast Name
Birthdate*

MonthDayYear
Date
Street / house number*
Zip code/town or city*
Email*
example@example.com
Phone number*
Employment / Profession*
Information on insured travel
Travel duration*

DayMonthYear
Date
hour : minutes
Actual end*

DayMonthYear
Date
hour : minutes
Details of the event insured
Claiming for:*
Day of onset of illness / day of accident*

DayMonthYear
Date
Accident location*
Information in case of illness
Type of disease (diagnosis)*
Since when do the complaints exist?*

DayMonthYear
Date
When were these treated for the first time?*

DayMonthYear
Date
Which physicians have been treating the persons suffering from the disease in the last 12 months prior to the start of travel?
Treating physician 1*
Name of treating physician
Clinic*
Date*

DayMonthYear
Street/house number*
Zip code/town or city*
Treating physician 2
Name of treating physician
Clinic
Date

DayMonthYear
Street/house number
Zip code/town or city
Who takes over further treatment after return?
Name of treating physician*
Clinic*
Date*

DayMonthYear
Street/house number*
Zip code/town or city*
Treatment period*

DayMonthYear
From (date)
DayMonthYear
To (date)
Information in case of accident
Cause / description of accident*
Parts of the body injured / nature of the injury (diagnosis)*
Has the accident been recorded by the police?*

YesNo
Police station*
Police reference*
Additional information
Was inpatient treatment required?*

YesNo
Please indicate the date*

DayMonthYear
From (date)
DayMonthYear
To (date)
Clinic*
Street/house number*
Zip code/town or city*
How did the insured person enter the return trip?*

As planned at the beginning of the tripBy ambulanceBy planeBy ambulance flight
Has the AIG emergency call centre been contacted?*

YesNo
Reasons*
Please list the costs incurred in detail

For this purpose, all invoices must be attached either in the original or in a photocopy with the reimbursement note of another insurer.
Please list the costs incurred in detail (For this purpose, all invoices must be attached either in the original or in a photocopy with the reimbursement note of another insurer)*
Information on indemnification
Has indemnification already been made by another side?*

YesNo
If yes, from:*
Name
Street/house number*
Zip code / town or city*
In the amount of:*
Amount
If it (still) has not been made, is indemnification requested?*

YesNo
If yes, at:*
Name
Street/house number*
Zip code / town or city*
Are there other travel insurance policies for the injured / ill person (travel expenses/protective letter/credit card insurance)?*

YesNo
If yes:*
Name of the company
Contract / Policy number*
Telephone number*
For which health insurance is the person concerned insured?
Name of the company*
Insurance number/membership number*
Street / house number*
Zip code / town or city*
Telephone number*
Was the insurance case of the health insurance already reported?*

YesNo
Reasons:*
Delayed luggage / flight insurance
Details of travel booked
Travel agent*
Destination*
Booked on*

MonthDayYear
Date
Airline*
Departure airport*
Arrival airport*
Outbound flight*

MonthDayYear
Date
Flight number*
Return flight*

MonthDayYear
Date
Flight number*
Details of the event insured
When were you informed about your delayed flight / luggage?*

MonthDayYear
Date
Hour MinutesAM/PM Option
Who informed you?*
(e.g. the airline, tour operator, official statement)
Reason for the delay*
(e.g. strike, blockade, technical fault)
When did the onward flight / luggage transport take place?*

MonthDayYear
Date
Hour MinutesAM/PM Option
When did you purchase the essential items you urgently required?*

MonthDayYear
Date
Amount of claim*
Has compensation already been provided?*

YesNo
If yes,*
Name of the company
Contract / Policy number*
Telephone number*
Are there further luggage / delayed flight insurance policies currently in force?*

YesNo
If yes,*
Name of the company
Contract / Policy number*
Telephone number*
Travel insurance
When and where did the event insured occur?*

MonthDayYear
Date
Hour MinutesAM/PM Option
Zip code / town or city*
Street / house number*
Country*
Notes*
Names of any persons travelling with you
Details of the trip
Travel agent*
Destination*
Booked on*

MonthDayYear
Date
Travel start date*

MonthDayYear
Date
Travel end date*

MonthDayYear
Date
Type of travel*

FlightBusHotelRailwayShipHoliday homeOther
If other:
Details of the event insured
Exact description of the event*
Is a third party at fault?*

YesNo
When did the event insured occur?*

MonthDayYear
Date
When was the trip cancelled/interrupted?*

MonthDayYear
Date
Non-refundable amount in accordance with cancellation invoice:*
Amount
Is there another travel cancellation policy in force for the trip booked?*

YesNo
If yes*
Name of the company
Contract / Policy number*
Telephone number*
Travel luggage
When and where did the event insured occur?*

MonthDayYear
Date
Hour MinutesAM/PM Option
Zip code / town or city*
Street / house number*
Country*
Notes*
Cause / course of events of the loss or damage*
Damage report
Damage report for:*

PoliceShipping companyLost-and-found officeAirlineRailwayHotel / PensionPostTravel agentOther
If other
Type of travel*

FlightBusHotelRailwayShipHoliday homeOther
Witnesses
Witnesses to the incident*
Other claims and insurance
Have you previously had your baggage damaged while travelling?*

NoYes
Type of claim*
Claim location*
Date*

MonthDayYear
Date
Reimbursed compensation*
Name of the company*
Contract / Policy number*
Telephone number*
Are there currently other travel baggage / mortgage / valuables insurance policies?*

NoYes
Name of the company*
Contract / Policy number*
Telephone number*
Details of loss/damage claimed
Do you have damaged glasses?*

NoYes
The health insurance fund takes over the share of:*
Amount
Details of loss/damage claimed*
Accident
Accident (death)
Names of any persons travelling with you
Incident informations
When and where did the event insured occur?*

MonthDayYear
Date
Hour MinutesAM/PM Option
Zip code / town or city*
Street / house number*
Country*
Notes*
Personal details

All the questions relate to the injured party / claimant.
First name*
Surname*
Date of birth*

MonthDayYear
Date
Address*

Street / house number

Street Address Line 2

Zip code / town or cityState / Province

Postal / Zip Code
Telephone Number*

Area CodePhone Number
Employment / Profession*
Email*
example@example.com
Accident details

All the questions relate to the injured person.
Cause / description of accident*
Parts of the body injured / nature of the injury (diagnosis)*
Were you under the influence of alcohol?*

NoYes
Was the claimant under the influence of alcohol?*

NoYes
During a business trip?*

NoYes
Occupational accident?*

NoYes
Accident while commuting (direct route from/to the place of work)?*

NoYes
Has the accident been recorded by the police?*

NoYes
Police station*
Police reference*
Which public prosecutor' office investigated?*
Name / Place
Reference*
Was an autopsy performed?*

NoYes
Initial medical assistance / hospital
Name of the treating physician / hospital*
Date*

MonthDayYear
Date
Street / house number*
Zip code / town or city*
Treating physicians / hospital after referral
Name of the treating physician / hospital*
Date*

MonthDayYear
Date
Street / house number*
Zip code / town or city*
Doctor / hospital certifying the death
Name of the treating physician / hospital*
Date*

MonthDayYear
Date
Street / house number*
Zip code / town or city*
General practitioner
Name of the treating physician / hospital*
Date*

MonthDayYear
Date
Street / house number*
Additional information
Was there a need for care at the time of the accident?*

NoYes
Level of care*

12345
Since*

MonthDayYear
Date
Did the injury result in an impairment to your fitness for work?*

NoYes
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Notes*
Was inpatient treatment required*

NoYes
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Notes*
Is a permanent disability anticipated?*

NoYes
Were you in perfect health before the accident?*

NoYes
Was the victim in perfect health before the accident?*

NoYes
Symptoms / conditions*
Have you had accidents previously*

NoYes
Had the victim had previous accident?*

NoYes
Informations about the previous accident(s)*
Were there other accident / life insurance policies in force at the time of the accident?*

NoYes
Were there other accident / life insurance policies in force at the time of death?*

NoYes
Name of the company*
Contract / Policy number*
Telephone number*
Information on indemnification
Has this loss been claimed from another insurance company?*

YesNo
If yes,*
Name of the company
Contract / Policy number*
Telephone number*
Has indemnification been paid?*

YesNo
Yes, in the amount of*
Amount
Business travel insurance
Confirmation of employer that it is a business trip*

Cancelof
Medical diagnosis report with the discharge report of the hospital*

Cancelof
Illness/accident
Medical diagnosis report with the discharge report of the hospital*

Cancelof
Healing costs
Documents, application forms for reimbursement, forms of health authorities,confirmation of insurance companies*

Cancelof
Baggage delay
Baggage receipt check-in*

Cancelof
Flight ticket*

Cancelof
Confirmation of the duration of the delay by the responsible location (Property Irregularity Report)*

Cancelof
Receipts for additional expenses / purchased supplies*

Cancelof
Proof of compensation provided*

Cancelof
Travel/Flight delay
Flight tickets with boarding cards*

Cancelof
Proof of delay of the airline*

Cancelof
Receipts for additional costs/expenses*

Cancelof
Travel withdrawal, cancellation of travel or change in travel
Flight tickets with boarding cards (copy)*

Cancelof
Flight tickets with boarding cards (copy)*

Cancelof
In case of illness/accident, medical diagnostic report with confirmation of the inability to travel*

Cancelof
Death certificate in case of death*

Cancelof
Other reasons: Receipts for the event entered*

Cancelof
Theft
Copy of the theft display at the responsible office (police report, etc.)*

Cancelof
Confirmation of the transport company (airline, etc.)*

Cancelof
Proof of compensation provided*

Cancelof
Damage
Confirmation of damage by the responsible location (property irregularity report)*

Cancelof
Receipts for purchase, replacement or repair*

Cancelof
Proof of compensation provided*

Cancelof
Report of the investigating authority*

Cancelof
Death certificate*

Cancelof

Policyholder
claimant_entityType*
Name

First NameLast Name
Email*
example@example.com
Phone number*
Street number*
Street*
Zip code/town or city*
Country*
Birthdate*

MonthDayYear
Date
Bank account details
Name*
Location of the financial institution
Account holder*
First name/surname
IBAN*
8 digits
BIC/SWIFT*
6 digits
Broker
Name*
Email*
example@example.com

Declaration
I/we have answered the questions above truthfully and in full.
In relation to your above statements, please note our communication attached under Art. 39 et seq. of the Federal Act on Insurance Contracts (VVG) concerning
the consequences of breaching your obligations arising from the event insured. You confirm receipt of this communication by providing your signature.
By signing, AIG is authorised to process the data necessary for processing the reported damage in your home country and abroad (including particularly
protected personal data such as health data). AIG is also authorised to obtain information from third parties, such as airlines, hotels, and other social and
private insurers, and to obtain information from them in their files. Furthermore, medical persons and their assistants are authorised to disclose to AIG the
data required for the processing of the present damage event and to expressly release these persons from their duty of secrecy.
Should be Empty:

Claim Notification

Do you have these documents?

Travel Health Insurance

Personal details

Information on insured travel

Details of the event insured

Information in case of illness

Information in case of accident

Additional information

Please list the costs incurred in detail

Information on indemnification

Delayed luggage / flight insurance

Details of travel booked

Details of the event insured

Travel insurance

Details of the trip

Details of the event insured

Travel luggage

Damage report

Witnesses

Other claims and insurance

Details of loss/damage claimed

Accident

Accident (death)

Incident informations

Personal details

Accident details

Initial medical assistance / hospital

Treating physicians / hospital after referral

Doctor / hospital certifying the death

General practitioner

Additional information

Information on indemnification

Business travel insurance

Illness/accident

Healing costs

Baggage delay

Travel/Flight delay

Travel withdrawal, cancellation of travel or change in travel

Theft

Damage

Policyholder

Bank account details

Broker

Declaration