NOTIFICATION OF CLAIM - any damage in your apartment

Please fill in the attached form! Fields that are labelled with * have to be filled out imperatively.

Mrs Mr Firstname Surname *          Email * Phone * Damage in your apartment:     Zip Code* City * Street * House No * Apartment No *        DAMAGE * Please choose ... water-damage storm-loss fire cullet How did the damage happened?      What was damaged? * Please choose ... flagstones wall paper floor others What was damaged ("Others")? In which room did the damage occur?     Please choose ... bathroom antechamber kitchen bedroom living room other room For water-damage: Which neighbouring apartments are concerned?        Please choose ... above below next door Are there any other parts of the house that where affected? YES NO   Other remarks