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Assignment form for a expertise order
Fields that are marked with * are required.
Power of attorney / Insurance comp. *
Correspondent *
  Sir     Madam  
E-mail adress
Phone number
INSURED
Intermediary *
  Sir     Madam  
Phone number
 
Counterparty (in case of liability)
Name
Name
Damage address
Address
Address
Address addition
Address
Address addition
ZIP code
ZIP code
Residence
Residence
Phone number 1
Phone number 1
Phone number 2
Phone number 2
Contact
Contact
E-mail
Address
Address
Address addition
ZIP code
Residence
Damage in favor of
Date of damage
Policy number
Ensured interest
Damage number
  Damage number does not apply
Policy conditions
Insured amount
Short discription and comments
(example, cause of damage, damage estimate)
Attachments
( for example police report, quotation, etc )
0%

 



 
  ( attachments ready )
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