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Claim Forms

    Home Claim Forms

    In a case of an incident please fill in the claim form bellow, describing the circumstances in detail.

    Our legal representative will contact you after receiving your claim form.

    • Accidents
    • Criminal
    • Medical Malpractice

    Claim Form - Accidents

    Personal Info

    Username:
    First name:
    Last name:
    E-mail:
    Telephone no:

    Date, Time & Place of the incident

    Date:
    Time:
    Place:

    Please determine the incident

    Accident with vehicle(s)Pedestrian accidentOther

    Your vehicle

    Plate numbers:
    Driver's license: ValidNot valid
    Vehicle ownership: OwnedRented

    Rental details:

    Insurance: InsuredNot insured

    Insurance type:Simple vehicle insuranceMixed vehicle insurance
    Insurance company:
    OwnedRented
    Plate numbers:
    Departure point:
    Arrival point:
    Sealine/Airline company:
    Departure point:
    Arrival point:
    (Other) vehicle involved YesNo

    Other vehicle

    Plate numbers:
    Driver's license: ValidNot valid
    Vehicle ownership: OwnedRented

    Rental details:

    Insurance: InsuredNot insured

    Insurance type:Simple vehicle insuranceMixed vehicle insurance
    Insurance company:
    OwnedRented
    Plate numbers:
    Departure point:
    Arrival point:
    Sealine/Airline company:
    Departure point:
    Arrival point:

    Please describe shortly the incident circumstances

    Was another person involved?

    YesNo

    Fault

    My faultOther's fault

    Incident consequences - Person covered

    InjuryDeathMaterial damageOther

    Pharmacy neededDoctor neededHospital needed

    Incident consequences - Other person

    InjuryDeathMaterial damageOther

    Pharmacy neededDoctor neededHospital needed

    Additional info

    Police involved: YesNo
    Ambulance involved: YesNo

    Drug tests

    Covered personYesNo

    PositiveNegative
    Other personYesNo

    PositiveNegative

    Alcohol tests

    Covered personYesNo

    PositiveNegative
    Other personYesNo

    PositiveNegative

    Please describe shortly the accident

    CLAIM

    Money compensation
    Moral compensation
    Notice the other party
    Notice the authorities
    Take actions on your behalf

    Claim Form - Criminal

    Personal Info

    Username:
    First name:
    Last name:
    E-mail:
    Telephone no:

    Date, Time & Place of the incident

    Date:
    Time:
    Place:

    Please determine the case

    Crime againstCrime committed by

    Criminal act(s)

    DUIMalicious woundingTheftRape/DebaucheryDrug offenceDriving without licenseSlander/ThreatOther

    Victim

    Name:
    Surname:
    Father's name:
    Mother's name:
    Citizenship:
    Gender: MaleFemale
    Other info:

    Describe the incident

    Additional information

    Police involvedCoast guard involvedArrestAmbulance involvedPharmacy neededDoctor neededHospital needed

    Criminal act(s)

    DUIMalicious woundingTheftRape/DebaucherySlander/ThreatOther

    Perpetrator

    Name:
    Surname:
    Father's name:
    Mother's name:
    Citizenship:
    Gender: MaleFemale
    Other info:

    Describe the incident

    Additional information

    Police involvedCoast guard involvedArrestAmbulance involvedPharmacy neededDoctor neededHospital needed

    CLAIM

    Money compensation
    Moral compensation
    Notice the other party
    Notice the authorities
    Take actions on your behalf

    Claim Form - Medical Malpractice

    Personal Info

    Username:
    First name:
    Last name:
    E-mail:
    Telephone no:

    Date, Time & Place of the incident

    Date:
    Time:
    Place:

    Exact Place

    Public HospitalPrivate HospitalPrivate ClinicOther
    Name:
    Location:

    People involved

    Name of doctor or other healthcare professional involved

    Details of other persons' involved (one person per line)

    Please describe shortly the incident circumstances

    Incident consequences

    InjuryDeathOther

    CLAIM

    Money compensation
    Moral compensation
    Notice the other party
    Notice the authorities
    Take actions on your behalf

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    Contact us

    Headquarters Address: 1 Aristidou str. 10559 Athens  - Greece

    E-mail: contact@tourist.legal

    Fax: +30 2130 799990

    Call ONLY if you are in an EMERGENCY need for legal assistance and you are NOT a TLA member. For information please contact us via our e-mail.+30 694 322 82 86

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