Accident Reporting Form

In order to evaluate your claim, we kindly ask you to fill the accident reporting form / FAIR (available for download below) and to send it back, as soon as possible, to Claims Department.

We kindly ask you to also include the following documentation:

  • copy of doctor medical report with diagnosis
  • copy of medical bill(s)
  • copy of bills of any incident-related cost you incurred in
  • if your incident occurred abroad, copy of travel tickets or original travel arrangement
  • copy of insurance certificate and/or policy of any of your other Accident and/or Health Insurance in force the day of your incident
  • copy of your identity document, such as Identity Card or Passport
  • your Bank Account data, such as Account-Holder name, IBAN, SWIFT/BIC

All of the above mentioned documentation should be first sent by e-mail for a preliminary evaluation by the Insurers. The invoices/bills shall be sent in original to the following mailing address, in order to proceed with the reimbursement of approved expenses:
 

DAN Europe Insurance Brokers Ltd 
Continental Europe Office - Claims Department 
C.da Padune 11 / 
64026 Roseto degli Abruzzi – Italy

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