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Application for indemnity

I am informed that AAS "CBL Life" processes personal data for the purpose of making a decision on the payment of insurance indemnity and the payment of insurance indemnity, providing that the rights are exercised in accordance with the Privacy Protection Rules.

Accident information

Please note, insurance does not cover minor bruises or contusions if they are not linked to a fracture or a sprain and do not require surgery. The policy also does not cover illnesses that were not caused by an accident.

Check the policy rules here to review all exclusions and coverage.

Contract number*

Date of the accident*

Time of the accident*

Description of the accident*

Information about the insured

Name*

Surname*

Identity number*

Phone number*

Email*

If an accident occurred

Attach documents issued by a medical institution. They must confirm the incident and describe the injuries, for example bone fractures or other health conditions.

If the insured person has died

Compensation is claimed by the beneficiary named in the policy or by the heirs. If you are the named beneficiary, include a copy of your passport or identity document.

The size of one uploaded document must not exceed 5 MB, and the total size of all documents must not exceed 30 MB. Allowed file formats: .pdf, .jpg, .png.

Documents *

Indemnity to be paid

Name*

Surname*

Identity number*

Account No.*

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