Distance contract and right of withdrawal form

We will prepare an insurance offer tailored just for you!

Fill in the form below, and we will contact you shortly.

Name

Surname

Email address

Phone number

Message

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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Provide your details so we can prepare the best MTPL offer for you

We will contact as soon as possible

Licence plate number

ID code of policyholder

Name

Surname

Email address

Phone number

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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We will prepare a CASCO insurance special offer for you!

Fill in an application form below and we will contact you as soon as possible

Licence plate number

ID code of policyholder

Name

Surname

Email address

Phone number

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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We will prepare Property Insurance offer special for you

Fill in an application form below and we will contact you as soon as possible

Name

Surname

Email address

Phone number

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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We will prepare Personal Accidents Insurance offer special for you

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Surname

Email address

Phone number

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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We will prepare Travel Insurance offer special for you

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Surname

Email address

Phone number

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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We will prepare Corporate Property Insurance offer special for you

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Insurance service you are interested in

Company name

Contact person name

Contact person surname

Email address

Phone number

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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Join our team

If you want to become part of our team and create your own success story, we are waiting for your resume and cover letter.

Name

Surname

Email address

Phone number

Desired positions

Curriculum Vitae

Cover letter

Message

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Report about an accident

Fill in the accident registration form below and we will get back to you shortly

Name

Surname

Email address

Phone number

Place of Accident

Date of Accident

What accident do you want to register?

Indicate the number of the insurance policy (Serial / No., eg 230/0000001)

Accident description

I agree that this is true.I agree that this is true.

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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Write to us!

Fill in an application form below and we will contact you as soon as possible

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Surname

Email address

Phone number

Choose your topic

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

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We will prepare a special insurance offer for you

Fill in an application form below and we will contact you as soon as possible

Name

Surname

Email address

Phone number

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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Report about an accident

Fill in the accident registration form below and we will get back to you shortly

Name

Surname

Email address

Phone number

Place of Accident

Date of Accident

What accident do you want to register?

Indicate the number of the insurance policy (Serial / No., eg 230/0000001)

Accident description

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. Vehicle photography instructions

Vehicle registration certificate

Driving license (of the person who was driving the car at the time of the accident)

Accident declaration or police certificate

Photos of the damaged vehicle (general view and damage, photos from the accident - up to 10 photos)

Maximum number of attached photos: 10

Free-form application for the transfer of the benefit to a person authorized by the owner (together with the vehicles, a copy of the owner's identity document)

Other documents not listed above

Defective act / repair estimate

Property acquisition documents (if you do not have - specify when and where the purchase was made)

Police certificate or information / messages from other services (PGT, ESO, emergency services, etc.)

Photos of the damaged property (up to 10 photos)

Maximum number of attached photos: 10

Supporting documents for expenditure incurred

Other documents not listed above

Medical documents (with date and diagnosis of injury)

Certificate of incapacity for work (if daily allowances are insured)

Certificate from the employer about the three months' salary received before the event (if you were injured in a traffic accident)

Certificate from SODRA on the duration of temporary incapacity for work and the benefits received during it (if you were injured in a traffic accident)

Copy of employment contract (if accidents are insured by the employer)

Other documents not listed above

Medical documents (with date and diagnosis of injury)

Travel documents (tickets, visas, etc.)

Proof documents of medical expenses

Other documents not listed above

I agree that this is true.I agree that this is true.

I agree that the contact details I have provided (telephone number and/or email address) will be used to obtain an opinion on the quality of the administration of this claim.

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

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General liability insurance damage

Reporter

Who is the submitter?

Submitter Name, Surname

Submitter Company Code/ Personal Code

Phone number

Email address

Insurance Policy or Certificate No.

Culprit data

Company name

Company code

Victim data

Is the submitter and the victim the same person?

Company name/ Name Surname

Company code/ Personal code

Address

Phone number

Email address

What damage has been done? Damaged movable / immovable property Damaged vehicle Injured health

Damaged property information

Transport Make Model

Licence Plate Number

Transport year

Body No.

Information on the damage suffered Medical expenses Loss of income Other treatment - related costs Non-pecuniary damage (€)

Other Expenses

Information about accident

Accident Date and Time

Accident Address

Accident Details

The authority was informed of the accident Police Fire Service Medical institution Emergency services Other

Name of the informed institution

Is the injured property / person insured under another insurance contract or with another insurance company?

Additional information

Beneficiary

The beneficiary is

Beneficiary (name, first name, surname)

Company code / personal code

Bank account No: LT11 1111 1111 1111 1111

Contact person

Who is contact person?

Name, Surname

Phone number

Email address

Documents

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. File size should not exceed 10 MB

Real Estate Register Certificate (In case of Real Estate)

Maximum number of attached photos: 10

Photos of damages

Maximum number of attached photos: 10

Certificate from the competent authority (if any)

Maximum number of attached photos: 10

Defective act

Maximum number of attached photos: 10

Other documents related to the accident

Maximum number of attached photos: 10

Photos of damages

Maximum number of attached photos: 10

Registration Certificate

Maximum number of attached photos: 10

Driver's license

Maximum number of attached photos: 10

Declaration / Police certificate

Maximum number of attached photos: 10

Evidence of injury

Maximum number of attached photos: 10

Certificate of time and duration of treatment

Maximum number of attached photos: 10

Certificate of incapacity for work

Maximum number of attached photos: 10

Supporting documents for expenditure incurred

Maximum number of attached photos: 10

Copies of medical documents

Maximum number of attached photos: 10

Other documents related to the accident

Maximum number of attached photos: 10

Certificate from the employer about 3 months' salary received before the event (only in case of loss of income)

Maximum number of attached photos: 10

I certify that all information is accurate, complete and true. I agree that the Insurer may reduce or refuse to pay the insurance benefit by knowingly providing incorrect data or concealing information that affects the clarification of the circumstances of the insured event.

Send

Corporate property insurance

Reporter

Who is the submitter?

Submitter Name, Surname

Submitter Company Code/ Personal Code

Phone number

Email address

Insurance Policy or Certificate No.

Company name

Company code

Damaged property

What property was affected? Real Estate Movable Property Stocks Cargo Other

Property Address

Information about accident

Accident Date and Time

Accident Address

Accident Details

The authority was informed of the accident Police Fire Service Emergency services Other

Name of the informed institution

Is the injured property / person insured under another insurance contract or with another insurance company?

Additional information

Beneficiary

The beneficiary is

Beneficiary (name, first name, surname)

Company code / personal code

Bank account No: LT11 1111 1111 1111 1111

Contact person

Name, Surname

Phone number

Email address

Documents

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. File size should not exceed 10 MB

Photos of damaged property

Maximum number of attached photos: 10

Extract from the real estate register

Maximum number of attached photos: 10

Lease agreement if the property is leased

Maximum number of attached photos: 10

List of damaged property

Maximum number of attached photos: 10

Property acquisition documents

Maximum number of attached photos: 10

Property Defect Act

Maximum number of attached photos: 10

Depreciation Act

Maximum number of attached photos: 10

Cargo contract / order form

Maximum number of attached photos: 10

Bill of lading

Maximum number of attached photos: 10

List of goods

Maximum number of attached photos: 10

Other documents related to the accident

Maximum number of attached photos: 10

Agree

My personal data (name, surname, email address, telephone number) would be used to provide the Insurer with information about special insurance service offers, promotions, loyalty programs, to obtain an opinion on the quality of service provision.

Agree Not agree

Send

Property Insurance

Reporter

Who is the submitter?

Insurance Policy or Certificate No.

Damaged property

What property was affected? Real Estate Movable Property

Address of damaged property

Unique Property Identification Number

Date of last repair

Company administering the building

Is the property mortgaged?

Beneficiary

Characteristics of damaged movable property (indicate which property is damaged, if you have / can indicate serial / model number, date of acquisition, etc.)

Information on the owner of the affected property

Owner's Name, Surname

Personal Code

Phone number

Email address

Inform me about the progress of the administration of the damage case By phone/SMS Email address By post

Information about accident

Accident Date and Time

Accident Address

Accident Details

The authority was informed of the accident Home Administrator Housing Cooperative Police Fire Service Emergency services Other

Name of the informed institution

Is the injured property / person insured under another insurance contract or with another insurance company?

Additional information

Whether the property of third parties (neighbors) was affected during the event

Information on the assets of third parties affected by the accident

Information on the assets of third parties affected by the incident

Contact details of third victims (telephone, Email)

Beneficiary

Name Surname

Personal code

Owner consent

Maximum number of attached photos: 10

Bank account No: LT11 1111 1111 1111 1111

Documents

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. File size should not exceed 10 MB

Real estate register certificate

Maximum number of attached photos: 10

Certificate from the competent authorities

Maximum number of attached photos: 10

Documents for the acquisition of damaged movable property

Maximum number of attached photos: 10

Defective acts of damaged movable property

Maximum number of attached photos: 10

Damaged property repair offer

Maximum number of attached photos: 10

Photos of damages

Maximum number of attached photos: 10

Accident Insurance

Reporter

Who is the submitter?

Submitter Name, Surname

Submitter Company Code/ Personal Code

Phone number

Email address

Inform me about the progress of the administration of the damage case By phone /SMS Email address By post

Insurance Policy or Certificate No.

Victim information

Name, Surname

Personal Code

Address

Phone number

Email address

Information about accident

Accident Date and Time

Accident Address

Accident Details

If you have been injured in a traffic accident or injured by others, provide the exact details of the police station where the investigation is taking place

Name of the Commission

If the victim was the driver of the vehicle, provide the driving license number

Driving license No.

Beneficiary

The beneficiary is

Beneficiary (name, first name, surname)

Company code / personal code

Bank account No: LT11 1111 1111 1111 1111

Documents

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. File size should not exceed 10 MB

a copy of an identity document

Maximum number of attached photos: 10

Copies of medical documents

Maximum number of attached photos: 10

police certificate (if you were injured in an attack or traffic accident)

Maximum number of attached photos: 10

Consent to the payment of a benefit to another person if the recipient of the benefits is not injured

Maximum number of attached photos: 10

MTPL insurance claim if you suffered injuries during a traffic accident

Reporter

Does the submitter and the victim coincide?

Submitter Name, Surname

Submitter Company Code/ Personal Code

Phone number

Email address

Inform me about the progress of the administration of the damage case By phone /SMS Email address By post

Accident participant (culprit)

Name, Surname

Transport Make Model

Licence Plate Number

Insurance Policy No.

Victim information

Name, Surname

Personal Code

Address

Phone number

Email address

Add another victim

Information about accident

Accident Date and Time

Accident Address

Accident description

Were you a passenger at the time of the accident?

I used a paid shuttle service at the time of the accident

Is the treatment complete?

Has incapacity for work been established as a result of the injury suffered?

Specify the period of incapacity for work from to

Did the accident occur during work, on the way to / from work?

Has the accident been reported to the police?

Name of the Commission

Information on the damage suffered Medical expenses Loss of income Other treatment - related costs Non-pecuniary damage (€)

Other Expenses

Additional information

Beneficiary

The beneficiary is

Beneficiary (name, first name, surname)

Company code / personal code

Bank account No: LT11 1111 1111 1111 1111

Documents

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. File size should not exceed 10 MB

Copies of medical documents

Maximum number of attached photos: 10

Supporting documents for expenditure incurred

Maximum number of attached photos: 10

Certificate from the employer about 3 months salary received before the event (only in case of loss of income)

Maximum number of attached photos: 10

Pažyma iš SODRA apie nedarbingumo laiką bei jo metu gautas ligos išmokas (tik negautų pajamų atveju)

Maximum number of attached photos: 10

Other documents related to the accident

Maximum number of attached photos: 10

Consent to the payment of a benefit to another person if the recipient of the benefits is not injured

Maximum number of attached photos: 10

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

My (my child's / representative's) health data would be processed for the purpose of claims administration, as well as my (my child's / representative's) personal data, including health data, from Lithuania or the consequences of the health care institution abroad, other state institutions / bodies and other third parties who have information related to the event and / or who may help to establish the fact of the insured event and the amount of the insurance benefit. ?

Agree

Send

Travel Insurance

Reporter

Who is the submitter?

Submitter Name, Surname

Submitter Company Code/ Personal Code

Phone number

Email address

Inform me about the progress of the administration of the damage case By phone/SMS Email address By post

Insurance Policy or Certificate No.

What damage did you suffer during the trip?

Accident Date and Time

Accident Place

Accident Details

Amount of losses incurred, Eur

Victim information

Name, Surname

Personal Code

Address

Phone number

Email address

Add another victim

Name of the institution where the first aid was granted

If you have been injured in a traffic accident or injured by others, provide the exact details of the police station where the investigation is taking place

Name of the Commission

Does the victim have travel insurance in another insurance company or bank that is valid abroad?

Name of insurance company / bank

Name of the carrier, travel agency

Planned baggage delivery location

Has the luggage been returned?

Date and time of baggage return

List of items in the luggage (In case of loss of luggage)

Date and time of connection loss

Cause of connection loss

Date of planned trip

Reason for missed trip

The date you learned that you would not be traveling

Has the tour operator / carrier compensated for the loss?

Amount of compensation, Eur

Beneficiary

The beneficiary is

Beneficiary (name, first name, surname)

Company code / personal code

Bank account No: LT11 1111 1111 1111 1111

Documents

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. File size should not exceed 10 MB

Medical records from the medical institution where the assistance was provided

Maximum number of attached photos: 10

Documents confirming medical and / or repatriation expenses

Maximum number of attached photos: 10

Proof of medical expenses

Maximum number of attached photos: 10

Documents proving baggage delay

Maximum number of attached photos: 10

Supporting documents for the necessary expenditure

Maximum number of attached photos: 10

Flight tickets

Maximum number of attached photos: 10

Documents for the acquisition of lost items in the former luggage (In case of lost luggage)

Maximum number of attached photos: 10

Police certificate (in case of luggage theft)

Maximum number of attached photos: 10

Documents confirming the loss of connection

Maximum number of attached photos: 10

Documents confirming the costs of changing the ticket or purchasing another ticket

Maximum number of attached photos: 10

Document confirming the reason for the missed trip (eg certificate from the medical institution)

Maximum number of attached photos: 10

Proof of purchase (e.g. tickets, hotel)

Maximum number of attached photos: 10

Documents of evidence of damage

Maximum number of attached photos: 10

MTPL insurance damage if you have suffered a vehicle insured by Compensa

Submitter

Is the submitter

Name, Surname/ Company Name

Submitter Company Code/ Personal Code

Phone number

Email address

Inform me about the progress of the administration of the damage case By phone/SMS Email address By post

Accident participant (culprit)

Provide the information you have. If you do not have the requested information, you do not need to fill it in

Licence Plate Number

Transport Make Model

Insurance Policy No.

Name, Surname

Telephone

Address

The car insured by ADB Compensa Vienna Insurance Group was affected

What property was affected? Property Vehicle

Affected assets

Owner of the affected property

Telephone

Email address

Vehicle Owner Information:

Name, Surname/ Company Name

Personal code/ Company Registration Code

Telephone

Email address

Accident information

Accident Address

Accident description

Vehicle / property damages

A traffic accident has been recorded Completed declaration In the police Other

Record the police station that was informed of the accident or record other information

Enter other information

Damage compensation

Preliminary amount of loss (in your opinion)

Method of compensation

ADB Compensa Vienna Insurance Group recommended car repair services
List of car repair services

Beneficiary information

Please pay the insurance benefit

Beneficiary (Name, Surname / Company name)

Recipient Personal Code/ Company Code

Bank account No: LT11 1111 1111 1111 1111

Vehicle in motion

Our experts will contact you for an inspection

If the policyholder is not found guilty during the investigation carried out by the competent authorities, I undertake to reimburse all or part of the insurance benefit paid to ADB Compensa Vienna Insurance Group. During the administration of the damage case, if it became clear that the vehicle was irreparably damaged during the accident and its repair was not economically expedient, I am informed that the technical data of the damaged vehicle and photos taken by ADB Compensa Vienna Insurance Group (without indicating the owner of vehicle and vehicle plate no.) are published on vehicle auction websites in order to determine the residual value of a damaged vehicle and to obtain the best bid for that vehicle.

Agree

Additional information

Documents

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. File size should not exceed 10 MB

Proof of ownership (e.g. registration certificate)

Maximum number of attached photos: 10

Driver's license

Maximum number of attached photos: 10

Accident declaration or police certificate

Maximum number of attached photos: 10

Damaged vehicle / property photos (general view and damage, photos from the scene - up to 10 photos)

Maximum number of attached photos: 10

Transporto priemonių fotografavimo instrukcija

Free-form request to transfer the benefit to a person authorized by the owner (together with a copy of the owner's identity document)

Maximum number of attached photos: 10

Other documents not listed above

Maximum number of attached photos: 10

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

Send

Reporter

Are the submitter and the driver the same person?

Reporter Name, Surname/ Company Name

Submitter Personal Code/ Company Code

Phone number

Email address

What is the most convenient way to contact you? By phone/SMS Email address By post

Insurance Policy or Certificate No.

Vehicle information

Licence Plate Number

Make/Model

Body No. (VIN)

Vehicle Owner

Name, Surname / Company name

Personal code/ Company Registration Code

Address

Telephone

Email address

Driver

Was the owner driving at the time of the accident?

Driving License No.

Driver's Name, Surname

Driver's Personal Code

Driver's Telephone

Other participants in the accident

Vehicle Third party assets Person

Vehicle

Driving License No.

Vehicle Make/ Model

Name, Surname

Address

Telephone

Third party assets

Damaged property (enter e.g. fence, barriers)

Owner of the affected property

Contact information

Person

Name

Surname

Telephone

Accident information

Accident Address

Accident description

Vehicle / property damages

A traffic accident has been recorded

Record the police station that was informed of the accident or record other information

Additional information

Is there now a CASCO insurance contract in our company?

Do you want to register an accident now under the existing CASCO contract?

Is the vehicle running?

After registering the damage, you will be contacted by an expert to inspect your vehicle

Preliminary amount of loss (in your opinion)

Method of compensation

repair information at the choice of the insurer and the policyholder

Beneficiary

Owner

Beneficiary (name, first name, surname)

Company code / personal code

Bank account No: LT11 1111 1111 1111 1111

Documents

Please provide available documents. If you have the opportunity, please attach photos of the damaged car or photos from the scene of the accident

Proof of ownership (e.g. registration certificate)

Maximum number of attached photos: 10

Driver's license

Maximum number of attached photos: 10

Accident declaration or police certificate

Maximum number of attached photos: 10

Damaged vehicle / property photos (general view and damage, photos from the scene - up to 10 photos)

Maximum number of attached photos: 10

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

Send

Vehicle damage claim if you have CASCO insurance

Reporter

Are the submitter and the owner the same person?

Name, Surname/ Company Name of Submitter

Submitter 's personal code / company code

Phone number

Email address

Inform me about the progress of the administration of the damage case By phone/SMS Email address By post

Insurance Policy or Certificate No.

Vehicle

Licence Plate Number

Make/Model

Body No. (VIN)

Vehicle Owner Information:

Name Surname/ Company

Personal code/ Company Registration Code

Mobile phone

Email address

Driver

Driver's Name, Surname

Driver's Personal Code

Driving License No.

Driver's Telephone

Accident information

Accident Address

Accident description

A traffic accident has been recorded Completed declaration In the police Other

Record the police station that was informed of the accident or record other information

Enter other information

Do you have MTPL insurance with Compensa Vienna Insurance Group and at the same time want to report the accident as the culprit?

Are there injured people?

Additional information

Licence Plate Number

Make/Model

Name of the insurance company, Insurance certificate No.

Damages to your vehicle

Is the vehicle running?

After registering the damage, you will be contacted by an expert to inspect your vehicle

Preliminary amount of loss (in your opinion)

Method of compensation

ADB Compensa Vienna Insurance Group recommended car repair services
List of car repair services

Beneficiary

The beneficiary is

Beneficiary (name, first name, surname)

Company code / personal code

Bank account No: LT11 1111 1111 1111 1111

If the policyholder is not found guilty during the investigation carried out by the competent authorities, I undertake to reimburse all or part of the insurance benefit paid to ADB Compensa Vienna Insurance Group. During the administration of the damage case, if it became clear that the vehicle was irreparably damaged during the accident and its repair was not economically expedient, I am informed that the technical data of the damaged vehicle and photos taken by ADB Compensa Vienna Insurance Group (without indicating the owner of vehicle and vehicle plate no.) are published on vehicle auction websites in order to determine the residual value of a damaged vehicle and to obtain the best bid for that vehicle.

Documents

In order to speed up the damage administration process, please provide copies (photos) of the documents listed below. If information is missing, we will contact you. File size should not exceed 10 MB

Driving License

Maximum number of attached photos: 10

Vehicle registration certificate

Maximum number of attached photos: 10

Police certificate (if the police were called at the time of the accident)

Maximum number of attached photos: 10

Photos (scene of the accident, car damages)

Maximum number of attached photos: 10

Transporto priemonių fotografavimo instrukcija

Consent to transfer the benefit to a non-owner

Maximum number of attached photos: 10

Other documents related to the accident

Maximum number of attached photos: 10

Accident declaration (if completed at the time of the accident)

Maximum number of attached photos: 10

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

Send

Seesam Health Insurance Claim
Seesam Health Insurance Claim

Inform me about the progress of the administration of the damage case

By phone /SMS Email address

Information about the insured

Name, Surname

Telephone (+3706)

Health Insurance Card No.

Bank account number

Email address

Personal code of the insured person

Description

Claim administration documents

Please indicate the services used to incur the costs and attach the available documents (invoice, receipts)

Outpatient treatment (research, consultations) (documents)

Outpatient treatment (documents)

Maximum number of attached photos: 10

Inpatient treatment (documents)

Inpatient treatment

Maximum number of attached photos: 10

Critical illnesses (documents)

Critical illnesses

Maximum number of attached photos: 10

Rehabilitation services (documents)

Medical rehabilitation

Maximum number of attached photos: 10

Dental treatment (documents)

Dental treatment

Maximum number of attached photos: 10

Medicinal preparations (documents)

Medicinal preparations

Maximum number of attached photos: 10

Over-thecounter medicines (documents)

Over-thecounter medicines

Maximum number of attached photos: 10

Optics (documents)

Optics

Maximum number of attached photos: 10

Preventive health examinations (documents)

Preventive health examinations

Maximum number of attached photos: 10

Preventive health examinations/Vaccinations (documents)

Preventive health examinations

Maximum number of attached photos: 10

Vaccines (documents)

Vaccines

Maximum number of attached photos: 10

Maternity care (documents)

Maternity care

Maximum number of attached photos: 10

Aesthetic procedures (documents)

Maximum number of attached photos: 10

Health promotion services (documents)

Maximum number of attached photos: 10

Advanced health insurance (documents)

Maximum number of attached photos: 10

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

SEND

Inform me about the progress of the administration of the damage case By phone /SMS Email address By post

Information about the insured

Name, Surname

Insurance policy no. (e.g. 190 0121215)

Telephone (+3706)

Email address

Personal code of the insured person

Bank account number

Description

Claim administration documents

Please specify the type of incident and attach any relevant documents.

Loss of employment at the initiative of the employer (employment termination document, confirmation of registration with the Employment Service)

Loss of employment at the employer's initiative (employment termination document, registration confirmation from the Employment Service).

Maximum number of attached photos: 10

Temporary incapacity for work - injury/illness (medical certificate, temporary incapacity certificate - bulletin)

Temporary incapacity for work – injury/illness (medical report, temporary incapacity certificate – sick leave document).

Maximum number of attached photos: 10

Death (death certificate).

Death

Maximum number of attached photos: 10

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

Send

LUMINOR purchase insurance damage

Inform me about the progress of the administration of the damage case By phone /SMS Email address

Information about the insured

Name, Surname

Bank account number

Personal code of the insured person

Last 4 digits of bank card

Telephone (+3706)

Email address

Information about accident

Accident Date

If the purchase is insured by Residential Property Insurance with another company, please indicate the name of the company.

Description

Claim administration documents

A purchase document confirming that the payment for the purchase was made with an insured payment card (card reader receipt, bank statement, etc.).

Purchase purchase document

Maximum number of attached photos: 10

Photos of damage, up to 10 pcs. At least one photo must show the name of the purchase, model, serial number, IMEI or other information identifying the purchase.

Photos of damage

Maximum number of attached photos: 10

Documents if the incident is registered with official institutions (police, fire department, etc.)

Documents if the event is registered with official institutions

Maximum number of attached photos: 10

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

Send

Complaint

Attached documents

Pin it

Attached documents

Maximum number of attached photos: 10

I confirm that all the information I have provided in this complaint is accurate and correct. I have read the Privacy Policy of the Lithuanian branch of ADB Compensa Vienna Insurance Group and Compensa Life Vienna Insurance Group SE regarding the processing of personal data.

Send

Registration form

Data of the registering person (parent, guardian)

Name of the registrant

Registrant's last name

Registrant's email

Registrant's phone number (+370)

Residential address of the registrant

City

Insured person

Name

Surname

Person's date of birth (insurance coverage only applies to primary school students)

I confirm that I have read the Company's Privacy Policy.

I agree to receive information about insurance services, products, special offers, news, loyalty programs for a period of 24 months.

„Compensa“ and „Compensa Life“

„Compensa“

I disagree.

More information about Compensa Life's processing of personal data

Send

Inform me about the progress of the administration of the damage case By phone /SMS Email address

Information about the insured

Name, Surname

Bank account number

Personal code of the insured person

Last 4 digits of bank card

Telephone (+3706)

Email address

Information about accident

Accident Date

If the purchase is insured by Residential Property Insurance with another company, please indicate the name of the company.

Description

Claim administration documents

A purchase document confirming that the payment for the purchase was made with an insured payment card (card reader receipt, bank statement, etc.).

Purchase purchase document

Maximum number of attached photos: 10

Photos of damage, up to 10 pcs. At least one photo must show the name of the purchase, model, serial number, IMEI or other information identifying the purchase.

Photos of damage

Maximum number of attached photos: 10

Documents if the incident is registered with official institutions (police, fire department, etc.)

Documents if the event is registered with official institutions

Maximum number of attached photos: 10

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

Send

Register and win 1 of 3 Kamado Bono grills!

Name

Surname

Year of birth

City

Phone number

Email address

I have read and agree to the rules of the game.

Register

Submitting a report

Name Surname/ Company

Telephone (+3706)

Email address

Select the company you want to report the violation to

Your relationship with the Company (employee, partner employee, client, etc.)

Detailed information about the violation (place and time of the violation, what the violation is, persons preparing to participate in the violation, participating or who participated in it, etc.)

Are there any witnesses to the violation (names, surnames, contact details of witnesses)?

Has the breach been reported to anyone else or who else knows about the breach?

Location of injury

Time of violation

I confirm that, in my opinion, the information provided and the statements contained therein are correct and that I have not knowingly provided false/incorrect information. I would like to receive confirmation of receipt of the message and information about the results of the investigation. I confirm that I have read the Privacy Notice regarding the processing of personal data related to the submitted report.

Send

Application for companies' employee health insurance

Please fill in the application and we will contact you to help you find the most suitable insurance solution!

Name

Surname

Email address

Phone number

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

Send

Write to us!

Fill in an application form below and we will contact you as soon as possible

Name

Surname

Email address

Phone number

Theme

Message

Please contact me By email address By phone number

I have read the Privacy policy regarding the processing of personal data

By ticking the consents, I confirm that I am informed that:
- my personal data will be processed for the above-mentioned purposes during the validity period of the insurance policy and 24 months after its expiry or, in the absence of an insurance contract and in the absence of an insurance policy, 24 months from the confirmation of this consent.
- I have the right to withdraw my consent to the processing of my personal data for the above-mentioned purpose at any time by contacting the Compensa Vienna Insurance Group customer service department by phone 8888 or by e-mail info@compensa.lv - more information about my rights in the field of personal data protection can be found in the Privacy Policy approved by Compensa Vienna Insurance Group.

Send

Register for a consultation

The service is available only to SEESAM health insurance clients who have chosen the health insurance program "OUTPATIENT TREATMENT"
If you register for a remote family doctor consultation after 5 p.m., the consultation will be provided the next day, in the time slot you selected in the registration form (if it is not a weekend day).
IMPORTANT! Consultations are not provided on weekends and festive days.

Услуга доступна только клиентам медицинского страхования SEESAM, которые выбрали программу медицинского страхования «Амбулаторное лечение»
Если осуществляется регистрация на дистанционную консультацию у семейного врача с 17:00 час., консультация будет предоставлена на следующий день, во временной отрезок, который вы выбрали в форме регистрации (если это – не выходной день).
ВАЖНО! Консультации не предоставляются в выходные и праздничные дни.

Name, Surname

Personal code

Choose how you would like to communicate. Choose how you would like to communicate

In what language would you like to receive the service? In which language do you prefer to receive the service

Select consultation type Choose the type of consultation

Phone number Phone number

Email Email

Policyholder/Employer Policyholder/Employer

Consultation date Consultation date

Consultation time Consultation time

Please be informed that for the purpose of registering a doctor's visit, Compensa Vienna Insurance Group, ADB will transfer the personal data you have provided in the registration form to Telesante, UAB (https://telesante.lt/en/), a provider of remote doctor consultation, health care licence No 4774. For more information on the processing of personal data, please refer to the Privacy Policy approved by Compensa Vienna Insurance Group, ADB.

Информируем, что в целях регистрации визита к врачу акционерное страховое общество «Compensa Vienna Insurance Group» передаст указанные Вами в форме регистрации персональные данные (за исключением информации о страхователе) ЗАО «Telesante» (https://telesante.lt/) (номер лицензии на уход за здоровьем: 4774). Больше информации по обработке персональных данных Вы можете найти в Политике конфиденциальности акционерного страхового общества «Compensa Vienna Insurance Group».

I confirm that I am aware that Compensa Vienna Insurance Group, ADB (company code 304080146, address Ukmergės g. 280, Vilnius) processes my personal data for the purpose of claim management. I am informed that I have the right to request access to my personal data, to request rectification or erasure or restriction of processing, to object to processing and to withdraw my consent to processing, as well as the right to data portability. I am also informed that I can find more information about the exercise of my rights and the processing of my personal data by the insurer in the Privacy Policy or at the insurer's registered office at Ukmergės g. 280, Vilnius. In the event of a personal data breach, I have the right to contact the Data protection officer via e-mail info@compensa.lv as well as to complain to the State Data Protection Inspectorate or to a court.

I confirm

SEND

Distance contract and right of withdrawal form

We will prepare an insurance offer tailored just for you!

Provide your details so we can prepare the best MTPL offer for you

We will prepare a CASCO insurance special offer for you!

We will prepare Property Insurance offer special for you

We will prepare Personal Accidents Insurance offer special for you

We will prepare Travel Insurance offer special for you

We will prepare Corporate Property Insurance offer special for you

Join our team

Report about an accident

Write to us!

We will prepare a special insurance offer for you

Report about an accident

General liability insurance damage

Reporter

Culprit data

Victim data

Information about accident

Beneficiary

Contact person

Documents

Corporate property insurance

Reporter

Damaged property

Information about accident

Beneficiary

Contact person

Documents

Property Insurance

Reporter

Damaged property

Information on the owner of the affected property

Information about accident

Information on the assets of third parties affected by the accident

Beneficiary

Documents

Accident Insurance

Reporter

Victim information

Information about accident

Beneficiary

Documents

MTPL insurance claim if you suffered injuries during a traffic accident

Reporter

Accident participant (culprit)

Victim information

Information about accident

Beneficiary

Documents

Travel Insurance

Reporter

What damage did you suffer during the trip?

Victim information

Beneficiary

Documents

MTPL insurance damage if you have suffered a vehicle insured by Compensa

Submitter

Accident participant (culprit)

The car insured by ADB Compensa Vienna Insurance Group was affected

Vehicle Owner Information:

Accident information

Damage compensation

Beneficiary information

Documents

Reporter

Vehicle information

Vehicle Owner

Driver

Other participants in the accident

Accident information

Beneficiary

Documents

Vehicle damage claim if you have CASCO insurance

Reporter

Vehicle

Vehicle Owner Information:

Driver

Accident information

Information about claim

Beneficiary

Seesam Health Insurance Claim
Seesam Health Insurance Claim