Report a claim

Primary contact

Policyholder

Phone number

Email address

Name of insured person

Date of birth

Position

Ship name

Harbour

Date of disability

Cause of disability

Is hospital admittance required? Yes (fill out contact information of hospital/doctor) No

Contact information hospital/doctor

Is repatriation required? Yes No

In case of repatriation, are you taking care of repatriation yourself? Yes No

Other actions/information