Revolut - Claim form

Hello, welcome to your Revolut claim form. This claim form is no longer used. Please follow the link below to access the new claim form
New claim form : Here

Hello, welcome to your Revolut claim form
Type of Revolut account*
accountType
Submission Date Claim

DayMonthYear
Date
do_not_send_report
entity_type*
claim_language*
Insurer*
Do you have any other insurance that might provide coverage for this incident?*
Please provide us with more information*
Insurer's identity, type of insurance, contract number, ...
Sorry but you need to have a Revolut Plus, Premium or Metal account to benefit from this insurance.

Before filing your claims please read the details below.

We don’t want you to waste your time and file a claim that might be not be eligible
Transportation tickets such as plane or train tickets are not covered by this insurance.

United Kingdom
Items purchased before December 9th 2020 are not covered by this insurance

Other countries
Items purchased before December 16th 2020 are not covered by this insurance

Ticket cancellation
This insurance only covers event tickets such as gigs, exhibitions, sporting events etc...
Transportation tickets are not covered.

Refund, damage & theft protection
Items like jewelry, antiques, foods and beverages, transportation tickets (plane, train etc), event tickets, softwares, mobile app, vehicles (bike ...) are not covered by this insurance.

This insurance does not cover any individual item that costs less than 50€ or £ for United Kingdom, except for the ticket cancellation protection
Transportation tickets (plane, boat, train ...) are not covered and for refund, damage & theft, any individual item less than 50€/£ are not covered Transportation tickets (plane, boat, train ...) are not covered and for refund, damage & theft, any individual item less than 50€/£ are not covered *

Claim Details
TheftDamagesRefund protectionTicket cancellation
coverage*
claimType
claim_subtype
Date of purchase*

DayMonthYear
Please mention the date of transaction

Please make sure you have the following documents at hand (you will be required to upload them later on):
Invoice or receipt of the item
We will need the invoice relating to the transaction you want to claim for. This must include the description of the item and the amount paid.

Police report
We will need a report from the police detailing theft & stating which items have been stolen.

For the UK : In case you do not yet have the police report, please upload
- a copy of your declaration to the police
- the crime reference number
Invoice or receipt of the item
We will need the invoice relating to the transaction you want to claim for. This must include the description of the item and amount paid

Pictures of damaged item
We will need picture(s) showing to what extent this item has been damaged

If the item has already been repaired : Repair-invoice
We will need the invoice for any repairs.

If the item still needs to be repaired or is unrepairable : Quote or formal statement from a repair shop
In case your item is repairable, we will need a quote from any repair shop.

In case your item can not be repaired, we will need a formal statement that the item can not be repaired from any repair shop.
Invoice or receipt of the item
We will need the invoice relating to the transaction you want to claim for. This must include the description of the item and amount paid

Proof of no-refund
We will need proof that the retailer will not refund you

Pictures showing the condition of the item and its packaging
Invoice or receipt of the item
We will need the invoice relating to the transaction you want to claim for. This must include the description of the item and amount paid

Proof of cancellation
We will need any official document justifying your inability to attend this event

Personal Information

Please provide us with the following
Name*

First nameLast name
Date of birth*

DayMonthYear
Email*
Please use the email address linked to your Revolut App
Phone number*
Which country is your Revolut App registered in?*
ref_country*

The item or ticket
Did you purchase the item online?*
Name of the company/store the item was purchased from*
Please provide as much contact information about the retailer as possible*
Name, address, phone number, email, website ...
Please provide us with your Revolut IBAN*
To locate your IBAN, click on your country's flag icon in the Revolut homepage under "Accounts"
Which payment method did you use to finalise the purchase?*
Specify other payment method*
Total amount (including VAT)?*
Currency*
Purchase invoice of the item or the ticket*

Must include the description, amount paid and retailer details such as its name and address (if applicable)
Cancelof
Date of Purchase
- For United Kingdom, only items purchased after the 09/12/2020 12 AM will be covered
- For other countries, only items purchased after the 16/12/2020 12 AM will be covered
Please note that items below 50€ are not covered by this insurance

The minimum of 50€ is applied for each object for which you file a claim
Please note that you will not be covered in respect of the first €50 of any claim

The incident - Theft

Please note that items below 50€/£ are not covered by this insurance
When did the theft occur?*

DayMonthYear
Date
Please describe what happened?*
Please select the item category*
Please provide a description of the item that was stolen*
Please upload a copy or picture of the police report*

For the UK : In case you do not yet have the police report, please upload- a copy of your declaration to the police- the crime reference number
Cancelof

The incident - Damage
When was the item damaged?*

DayMonthYear
Please describe what happened?*
Please select the item category*
Please provide a description of the item that was damaged*
Please upload picture(s) of the damaged items*

For the UK : In case you do not yet have the police report, please upload- a copy of your declaration to the police- the crime reference number
Cancelof
Is it a total loss?*
Please upload a written statement from a repair shop*

We need proof that the item is considered a total loss (or write-off), it can be a repair quote for a higher amount than the original value of the item or a written statement from a repair shop
Cancelof
Please upload a scan or picture of the repair invoice/quote*

The amount of the repairs must be clearly visible
Cancelof
- Please note that if your item is in total loss, you may be requested to ship the item to Qover's head office in Belgium.
- Depending on your country, please note that items below 50€/£/CHF are not covered

The incident - Ticket cancellation

Please note that transportations ticket are not covered by this insurance
Please select the type of ticket*
ticketType
When was the event meant to happen?*

DayMonthYear
Date when the event was cancelled*

DayMonthYear
Provide the date when event was cancelled or the cancellation was communicated
Please describe what happened ?*
Cancellation reason*
Please upload proof of the above*

Cancelof

The incident - Refund
Reason for your request*
When did you request a refund from the retailer?*

DayMonthYear
Date
Please describe what happened*
Please provide pictures showing the state of the item and its packaging*

Cancelof
Please upload pictures showing the condition of the item and its packaging*

Cancelof
Please select the item category*
Please provide a description of the item for which you want a refund*
Please be informed that you will be requested to ship the item in its original packaging to Qover's head office in Belgium for your claim to be successfully treated. Shipping cost are covered by us for up to 50 €/£/CHF

Data Protection, Fraud Prevention and Detection
claimSubtype
Specify other payment method*
itemCategory
I agree with the Privacy Terms
Qover is carrying out claims handling services on behalf of Chubb and Wakam. We (Qover,Chubb and Wakam) carefully assess your claim, and also take steps, in common with standard industry practice, to monitor for fraudulent claims. For these reasons, we may need to use information about your health which is relevant to your claim, and, where relevant, the health of other persons relevant to the claim which you provide to us. You must ensure that any other persons whose information you provide to us understand and do not object to this use of their data, and (where required under applicable law) consent to us using their information for the purposes described in our privacy policies.
Regarding the processing of your data (including sensitive data) and regarding the information of third parties you provide us, you can find our privacy policies here:

- Chubb privacy policy
- Qover privacy policy

We will not use this health information for any other purpose, and will comply at all times with the terms (including security standards) referred in our Privacy Policy. You do not have to provide us with the following consent, and you may withdraw it at any time, but if you do not provide it, or choose to later withdraw it, that may affect our ability to process your claim.
I agree to the processing of my data (including sensitive data) by Qover
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 the UK, 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:

Hello, welcome to your Revolut claim form. This claim form is no longer used. Please follow the link below to access the new claim form

New claim form : Here

Hello, welcome to your Revolut claim form

Before filing your claims please read the details below.

Claim Details

Please make sure you have the following documents at hand (you will be required to upload them later on):

Personal Information

The item or ticket

The incident - Theft

The incident - Damage

The incident - Ticket cancellation

The incident - Refund

Data Protection, Fraud Prevention and Detection