Bike Claim Form

Bicycle theft or material damage claim
Choose which claim you want to report *
claim_type
send_report
claim_sub_type
Reference n° of your contract *
What is your bicycle type? *
bicycle_type
claim_language
Country
ref_country
Claims Handler
claimant_entityType

Personal Information

Please provide us with the following personal details
What is your name? *

First Name Last Name
What is your date of birth? *

Day Month Year
Phone Number *
Email *
IBAN number *
Please add your IBAN number for your compensation.
Upload your RIB *

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Is your bike equipped with a GPS tracking device ? *
gps_tracking
Is the GPS tracking device built in the bike? *
gps_built_in
Which brand is the GPS tracking device? *
Upload the invoice of the GPS tracker *

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Does your bike have any additional markings? *
What is the bike marking type? *
is_Bike_markings
What is your bike marking ID? *
Copy of the invoice of the purchase of your bike *

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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.
If you have the coverage “cash emergency” you can claim up to 880PLN 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 1500 kr. 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 2050 kr. to complete your journey by taxi or public transport and for a rental bike while your bike is being fixed.
Do you have this "Cash Emergency" coverage in your contract ? *
(This guarantee is limited to 3 claims per insurance year.)
cash_emergency_coverage
To complete your claim, you can already upload any invoices or receipts here.

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If you still need to rent your bike, you can still upload documents later.
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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.

Please find Qover's Privacy Policy and Cookies policy here.
Nationale-Nederlanden registreert schademeldingen en verzekeringsgegevens in de CIS-databank. Stichting CIS bewaart deze gegevens voor verzekeringsmaatschappijen die in Nederland actief zijn. Zo kunnen verzekeraars, politie, justitie en andere door Stichting CIS erkende instellingen onderling informatie uitwisselen. Daarmee kunnen ze risico’s beheersen en fraude tegengaan. Meer informatie vindt u in het CIS Privacyreglement op www.stichtingcis.nl.

Op de verwerking van uw persoonsgegevens is het privacystatement van toepassing. Dit kunt u vinden op www.nn.nl/privacy.

Nationale-Nederlanden Schadeverzekering Mij. N.V. (statutair gevestigd te Den Haag), handelsregisternr. 27023707
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I have read and agree with the Privacy Policy and Cookies Policy of Qover
Should be Empty:

Bicycle theft or material damage claim

Personal Information

Incident report

Cash Emergency

Data Protection, Fraud prevention & detection