The reminder or the legal reminder was issued incorrectly

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

What have you received?

Form UUID

Checksum

ThankYou-page URL

Form sub-type

Hidden controls

Client context

Agency ID

Interest ID

Server context

Does it concern an open claim arising from premium invoice?

Yes

Please enter the reason

Reason

Please state your policy number or reference

Policy number

AXA Reference number

Please note:
You will find this information at top right of the communication you received.

Policyholder

Title

Mr.

Ms.

Company

First name

Last name

Street

House number

PO Box

Postcode

Place

Country

Which country

Phone number

Email address

Re-enter the email address