Insurance claim form

Insurance claim

Customer

Company/municipality *

Department/School *

Adress *

Zip code and city *

Claimant / Contact person from school

Name *

E-mail *

Mobile number

Contact information of user

Name of user

E-mail to user

Mobile number to user

Who to contact for questions?

Claimant
User

Return address for equipment after service

Don’t fill out if the information is the same as above

Name

Address

Zip code and city

Extent of damage

Place of incident *

Description of incident *

Start day leasing/rent/loan agreement

Date damage occurred *

Time *

Brand and type of equipment damaged *

Serial number *

NOTE: Police report must be attached when burglary, theft, or loss

Enclosure

Agreement and purchase information

Agreement no. (for example 3xxx-00x) *

Atea invoice/order number

Do you have a damaged unit which is covered by the Atea Finance insurance? Then you can make a claim with this form. If you think the damage is known and occurred during normal use, we ask you to fill out Our Return form

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