Health insurance claim notice

Notifier details

First name

Last name

Country of residence

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Sufferers

I am a sufferer

Sufferer's details

First name

Last name

Country of residence

Personal ID code

Personal ID code / date of birth

E-mail

Phone number

Add more people

Insured event

Type of insurance event

The time of initial detection of the disease

Brief description of the disease

0/250

Time of the accident

Place of the accident

0/250

Brief description of the accident

0/250

The medical institution to which you have applied

0/250

Notification Date

Additional information and confirmations

Additional information of the insured event

0/1000

I confirm the accuracy of the above data and agree to the processing of my personal data by LHV Kindlustus in accordance with the principles of LHV customer data processing.

I know that if I knowingly submit wrong data, then insurer has the right to decrease compensation or refuse to pay compensation completely.

I agree that insurer has the right to request additional information concerning the claim from persons that possess it.

Health insurance claim notice

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