Home Claims Claim form
Online Claim Form
  1. If you are in need of urgent or emergency repairs, please contact us on +32 2 267.92.26.
  2. Full Name(*)
    Please type your full name.
  3. E-mail(*)
    Invalid email address.
  4. Phone number
    Invalid Input
  5. Full address(*)
    Invalid Input
  6. Date of birth(*)
    Invalid Input
  7. Preferred contact
  8. Best contact time
    Invalid Input
  9. Please select claim insurance category
    Invalid Input
  10. Policy number(s)
    Invalid Input
  11. Accident/Incident details
  12. Date incident
    Invalid Input
  13. Time incident
    Invalid Input
  14. Accident/incident description
    Invalid Input
  15. How much is five + 3 ?(*)
    Invalid Input
    (antispam control)
  16.   
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Fast service

Car accident? Water damage to your home? We make sure you receive immediate help. Efficient handling of these situations is our trademark.


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Contact Us

Feel free to get in touch with us!

Address:
St Annalaan, 209 B-1853 Strombeek-Bever
Tel: +32 2 267.92.26
Fax: +32 2 267.28.32
FSMA 020259 A-cB
Email: expatinsurance@copper.be