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  • Claim Form

  • ✅ The Rewire users registered in those countries can submit a claim :

    Belgium, Germany, Estonia, Spain, Finland, France, Greece, Ireland, Italy, Lithuania, Luxembourg, Latvia, Malta, Netherlands, Poland, Portugal, Slovenia, Slovakia

    ❌ The Rewire users registered in United-Kingdom, Cyprus or Austria are not eligible to the insurance program and therefore are not allowed to submit a claim

  • What is covered: 

     ✅ The insured dies as a direct and only consequence of that Accident.

     

    What is not covered: 

    ❌ Death due to another cause than accident (e.g. sickness).

    ❌ Temporary total Disability (i.e. you will recover from your accident). Please select "Temporary Total Disability".

    ❌ Dismemberment or paralysis. Please select "Dismemberment or paralysis".

    This is not an exhaustive list. Please check the terms and conditions for the complete list.
     

    Please prepare the following documents:

    📄 Death Certificate

    📄 Cost expenses (If the burial has already been done in Europe)

    📄 All documents describing the accident such as police report, accident report, witness report,...

  • What is covered: 

     ✅ Paralysis: The permanent, total and irrecoverable loss of the ability to move (parts of) the body as a result of accident

     ✅ Dismemberment: The loss of a body part. 

     

    What is not covered: 

    ❌ Sickness 

    ❌ Temporary total Disability (i.e. you will recover from your accident). Please select "Temporary Total Disability"

    ❌ Accidental Death. Please select "Accidental death"

    This is not an exhaustive list. Please read the terms and conditions for the complete list.

     

    Please prepare the following documents:

    📄 Medical report 

    📄 All documents describing the accident such as police report, accident report, witness report,...

  • What is covered: 

     ✅ Inability to work for 14 days consecutive as a result of an accident. 

     

    What is not covered: 

    ❌The inability to work as a result of sickness 

    ❌ Permanent Disability (e.g. Dismemberment or paralysis). Please select "Dismemberment / paralysis"

    ❌ Accidental Death. Please select "Accidental death"

     This is not an exhaustive list. Please read the terms and conditions for the complete list.

     

    Please prepare the following documents:

    📄 Medical report 

    📄 Medical certificate of temporary total disability

    📄 All documents describing the accident such as police report, accident report, witness report,...

  • Those data are present to orient properly the emails from jotform

  • Personal information of the insured

    The insured is the ReWire customer whose interest is protected by the insurance
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  • Personal information of the claimant

    The claimant is the person who is acting on behalf of the insured
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  • Accident information

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  • Address of the accident

  • Medical information

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  • Death location

    Please provide the place where the insured deceased
  • Occupational information

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  • Evidences and attachments

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  • Declaration

  • Personal data

  • Your personal data (hereinafter the ‘data’) will be collected and processed by AIG Europe, Netherlands, located at the address above (hereinafter ‘AIG’) in accordance with the Code of Conduct for the processing of personal data by financial institutions (‘Code of Conduct’). AIG is the controller responsible for the processing of the personal data you are required to share to benefit from the AIG insurance product. The data will be processed only for the purpose of the use of the services provided by AIG, including risk assessment, insurance contract management, claims handling and crime prevention (such as fraud) as well as to allow AIG to fulfill its legal obligations. In connection with AIG’s activities and for the purpose of good service, AIG may transfer these data to other companies of the group of companies it belongs to, to subcontractors, insurance intermediaries such as Qover and Rewire or to partners. These companies, subcontractors or partners may be located in countries outside the European Economic Area that do not necessarily offer the same level of protection as The Netherlands. With regard to these transfers, AIG will take precautionary measures to ensure the protection of data in these countries as well as possible. You allow Rewire, AIG and its processor Qover to share and process your personal data including your ReWire IBAN number among each other for the above purposes. According to the Code of Conduct, you are entitled to access, amend or oppose (for a reasonable cause) to the processing of data related to you. To exercise these rights, you can contact AIG at any time in writing at functionarisvoordatabescherming.nl@aig.com. For further information on the mechanisms for processing your data by AIG, you will find AIG’s complete Global Privacy policy on http://www.aig.com/nl-privacybeleid

  • CIS Foundation

  • In order to ensure a responsible acceptance, risk and fraud policy we may check your (personal) data and have it recorded in the CIS Foundation, Bordewijklaan 2, 2591 XR The Hague, PO Box 124, 3700 AC Zeist. The purpose of processing personal data in CIS is to detect the abuse of financial products and services of insurers, preventing, combating and controlling risks to the fullest extent. For more information, see www.stichtingcis.nl.

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