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(*)
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  4. Phone number
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  5. Full address(*)
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  6. Date of birth(*)
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  7. Preferred contact
  8. Best contact time
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  9. Please select claim insurance category
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  10. Policy number(s)
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  11. Accident/Incident details
  12. Date incident
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  13. Time incident
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  14. Accident/incident description
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  15. How much is five + 3 ?(*)
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    (antispam control)
  16.   
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Welcome Package

The Welcome Package covers all your insurance requirements for a period of 60 days at a cost of only 1 € a day.


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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