The reminder or the legal reminder was issued incorrectly

1What have you received?
2Please enter the reason
3Please enter the reference number (claim number) or the policy number
4Policyholder
5You have almost completed the form

What have you received?

Does it concern an open claim arising from premium invoice?

Please enter the reason

Please enter the reference number (claim number) or the policy number

Please note:
You will find this information at top right of the communication you received. e.g. XX.XXX.XXX, XXXXXXXX, X.XXX.XXX/XXXX, XXXXXXXX/XXXX

Policyholder

Title

Contact person

Title

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