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Casco Claim Application

Page updated 21/05/2024 18:50

Casco Claim Application

Completion of this application is not considered to be the evidence for the insured event

Information on Policy Holder

Policy Holder Is:

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Insured Car Owner's Bank Details

The provision of reimbursement is paid only in a non-cash way

Insured Car Information

Is the car insured by other insurance company?

Information on Accident

    I undertake

    Did you contact authorities from the scene of the incident (Police, Customs etc.)?

    In your opinion is somebody liable for this incident?

    Did you receive reimbursement from the person who caused the damage or another person responsible for causing the damage (for example, under an CMTPL contract)?

    Information on The Driver

        Information on The Applicant

        The Applicant is:

              Statement

              1. I confirm that the information provided in this claim and the documents submitted are correct and true, and I understand that if I submit false information and/or documents, I will be held liable in accordance with the law, and this claim will be rejected.

              2. I confirm that I have read this document, I fully understand and am aware of the nature of my obligations defined by the above-mentioned insurance contract, the legal and economic consequences of their non-fulfillment or improper fulfillment.

              3. I undertake to present the insured vehicle to the Insurer within 7 (seven) working days after the damage has been repaired (restored), providing an opportunity for inspection.

              4. I undertake to return the amount of compensation paid or overpaid on the basis of this claim within 30 (thirty) working days, if after its payment it turns out that in the cases and grounds defined by RA law and "Voluntary Car Insurance Conditions", compensation was not subject to payment to me, or a compensation less than what was paid should have been paid.

              5. I give my consent to the Insurance Company to publish insurance or other confidential information about me, to the extent they are necessary, according to the Insurance company, to carry out the insurance compensation process properly, as well as certain inspections related to it and to effectively exercise the right to claim back due to the payment of compensation.

              6. I am informed that during the validity of the Contract in case of non-fulfilment or improper fulfillment of the obligation of clause 3, when determining the amount of compensation for damage caused by an accident that occurred later, the costs for missing or damaged parts, details, aggregates, joints of the insured car, as well as the costs of their repair, replacement, installation works, which were defined during the inspection within the framework of this claim will not be taken into account.

              7. I am informed that I have the opportunity to change the manner of receiving the compensation mentioned by me in this claim later.

              8. I understand that the Insurance Company may request other documents justifying the damages caused as a result of the accident.

              9. I understand that if the data given in this claim do not correspond to the data obtained by the Company from other reliable sources (for example, the time of notification of the accident mentioned in this claim is different from the time of the actual call), then the data obtained from the most reliable sources will be used.

              10. I consent that the Insurer processes the data provided for services.

              Within 15 (fifteen) business days from the date of receiving all necessary documents, the Insurer makes a decision regarding the recognition or non-recognition of the event, which has the characteristics of an insured event, as well as the provision of insurance compensation or the refusal thereof.

              Ներբեռնի՛ր ԼԻԳԱ հավելվածը և ստացիր զեղչի պրոմոկոդեր բոլոր ապահովագրության տեսակների համար։

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