Language
  • English (UK)
  • Français
  • Nederlands
  • Deutsch
  • Español
  • Português
  • Italiano

  • Bicycle theft or material damage claim

  • Personal Information

    Please provide us with the following personal details
  •  -  -
    Pick a Date
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of
  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of

  • Incident report

  •  -  -
    Pick a Date
  •  -  -
    Pick a Date
  •  -  -
    Pick a Date
  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of
  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of
  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of
  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of
  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of
  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of

  • Cash Emergency

  • If you have the coverage “cash emergency” you can claim up to 200€ to complete your journey by taxi or public transport and for a rental bike while your bike is being fixed.

  • If you have the coverage “cash emergency” you can claim up to 200£ to complete your journey by taxi or public transport and for a rental bike while your bike is being fixed.

  • If you have the coverage “cash emergency” you can claim up to 150€ to complete your journey by taxi or public transport and for a rental bike while your bike is being fixed.

  • Choose a file
    Drag and drop files here
    Choose a file
    Cancel of

  • Data Protection, Fraud prevention & detection

  • In order to administer your claim, this information will be used by Qover, the claim adjuster and the insurer. 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. You also consent to our transferring of your information to countries which do not provide the same level of data protection as Belgium, if necessary for the above purposes. If we do make such a transfer we will, if appropriate, put a contract in place to ensure your information is protected. 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.

  • Should be Empty: