Benefits

Information about Insured person:

Name

Surname

Address

Personal ID number

E-mail

Telephone number

Information about applicant
Information should be provided, if applicant and insured are different persons

Applicant and insured person are the same

Name

Surname

Type of connection to the Insured (friend, family member, close relative and so on)

Insurance products:

Benefits Protector
Global Protector
Health Protector
MY BENEFIT

Other

Property Insurance
Auto Insurance

Other

Type of the pretension:

Describe pretension:

What type of response do you prefer?

By post as letter Electronic

By submitting this application, I declare and confirm that::

The data provided in the application is true and I have the appropriate authority to submit the application and / or I have obtained all the necessary consent / permission;
I am fully responsible for any damage / loss caused by submitting the application to the insurer;
An application submitted in electronic form has the identical legal force of an application submitted in material form.