Online damage report Change policy. Change address. Online damage report Report damage. Fields marked with an * are required. Policy & claim. * Policy number Customer number * Claim type DeclarationPermanent incapacityEuthanasia of deathTheftCivil liability Policy holder. * Name Street and number Postal code City * IBAN * Email address * Phone number Data horse. * Horse name Gender MareStallionRuin Date of birth * Chip number Damage details. * Have you (already) reported the damage to us? YesNo Date of prior damage report * Date of damage * Time of damage * Location of damage * Moment of damage CompetitionOn loan to third partiesTrainingRecreationStable or grazing * Description of circumstances and damage * Has the horse been presented to multiple vets for this claim? YesNo * What is the reason for this? * Has the horse been referred by your own vet? YesNo * To which clinic? Where has your horse been treated? ClinicStable addressOther Treated at * Is there a recurring phenomenon? YesNo * Detailed explanation Attachments. Signed report and/or patient report from your veterinarian Original note(s) If made, imaging (Ultrasound/X-ray) Signed, substantiated (rejection) report and/or patient report from your vet If taken, imaging (echo/x-ray/CT/MRI/digital images/Film clip Euthanasia statement Police report Digital photos of burglary damage Rejection of own AVP/WA insurance Pro forma invoice damage/assessment damage Digital photos damage The above information has been provided truthfully and may be processed Change policy. Policy change. Fields marked with an * are required. * Policy number * Effective date change * Your name * Email address * Street and number * Postal code * Town/village * What do you want to change? Change address. Address change. Fields marked with an * are required. * Policy number * Effective date change * Your name * E-mail address Old address * Street and number * Postal code * Town/village New address * Street and number * Postal code * Town/village