Production -GLOVO - Courier Accident

Courier Accident
Please note the following before filing your claim
- This insurance covers you for accidents that occured when you are connected with Glovo and up to one hour after you logged-out of the application
- This insurance does not cover the damages to your possessions, for example your bicycle or your phone are not covered by this insurance.
- You will be requested to upload pictures of the accident and to upload any document that will help us to process your claim (e.g. medical certificate, receipts from the hostpital, police report ...) .
- If you have an insurance for your vehicle and your vehicle was damaged, do not forget to let your insurance company know about the accident.
Country*
If your country is not listed in the above dropdown please click here.
do_not_send_report
coverage
form_name
claim_type
subType
claimLanguage
claimantEntityType
refsCountry
claimhandler

Your personal information

Please provide us the following details
Name*

First NameLast Name
Birthday*

DayMonthYear
Date
Email*
example@example.com
Phone Number*
Where do you live ?
Street*
Number*
Box*
Apartment, unit, suite number
Locality
Postcode *
City*
Country*
claimant_address_country
brokerName
fromEmail
replyTo
example@example.com

Identification and bank account details
Please upload a picture of your ID or passport.*

Cancelof
Does this Glovo account belong to you, or is it in the name of a third party that legally subcontracted you?*
glovoRiderType*
What is your bank account number?*
In case of eligible claim, we might need it for reimbursement. For Europe : IBAN format is requested
Please check this box to confirm that you are the holder of the Iban provided. Please note that any errors in this field may result in delays in receiving refunds.*

I confirm I'm the holder of the Iban provided above.

Accident information
When did the accident take place?*

DayMonthYear
Date
Hour Minutes
City of the accident location*
Street and number of the accident location
Vehicle you used at time of incident*
riderVehicleType
Was a third party involved in the accident?*
Do you want to claim medical costs?*
Do you want to claim work incapacity?*
Do you want to claim for broken bones, strains, dislocations or suture (more than 5 stitches) ?*
Describe the accident*
Provide a detailed description of the accident
Please describe your injuries as a result of this accident*
Please upload a screenshot from your Glovo app of the last order you had at the time of accident (or just before)*

Cancelof

Required documents
Please upload medical documents

All medical documents describing the bodily injuries and the prescribed treatment, such as: first medical assistance report, any additional medical reports
Cancelof
Please upload all receipts or bills for medical costs with proof of payment

All documents for medical costs that you paid after the accident (hospital care, medication, physiotherapy) with the related proof of payment and medical prescriptions.
Cancelof
Please upload the medical certificate of temporary disability (the initial or extended medical leave, or the discharge report)

Please upload the document provided by your doctor indicating your incapacity to work for more than 7 days.
Cancelof
Please upload here any other important documents linked to the accident that you haven’t submitted yet

Any additional document(s) describing the accident such as : police report, accident report, witness report,...
Cancelof
Remember: Your claim will only be evaluated upon receipt of all necessary documents If you don't have one of the documents right now, you can still submit your claim and provide additional documentation by email later.
I acknowledge that my claim will be assessed only upon receipt of all necessary documents.

I understand.

Data Protection, Fraud Prevention and Detection & Medical information
In order to administer your claim, this information will be used by the claim adjuster and the insurer and their subcontractors. It may be held on computer and or in manual files for administration and risk assessment purposes.By returning this form, you consent to our processing of your sensitive personal data for the above purposes. Where you have provided information about another person, you confirm that they have appointed you to act for them, to consent to the processing of their personal data, including sensitive data, to the transfer of their information abroad and to receive on their behalf any data protection notices.*

I agree with the Privacy Terms
In order to carefully process your claim, Chubb will process the personal data you provide to us. We might process these data to analyse possible fraudulent claims. Please note that you can exercise your data protection rights as indicated in our privacy policy of our website at https://www.chubb.com/es-es/footer/privacy-policy-en.html Please ensure that anyone else whose data is provided understands and does not object to the processing of their data. We may process health data that are essential without the need to obtain your explicit consent, as it is permitted by article the 99.2 of Law 20/2015 of July 14, on the organisation, supervision and solvency of insurance and reinsurers for the payment of compensation or the benefit derived from the insurance contract. Please note that we will not use health provided information for any other purpose and will comply, at all times, with the security measures and standards mentioned in our Privacy Policy.
I agree with the Privacy Terms
Should be Empty:

Courier Accident

Your personal information

Where do you live ?

Identification and bank account details

Accident information

Required documents

Data Protection, Fraud Prevention and Detection & Medical information