Claims form

Insurance certificate number

Name, Surname, Represented company

Date of incident/date of receipt of claim from third parties

When the works/services for which the claim is made were performed (FROM)

When the work/services for which the claim is made (DUE)

Attach the relevant documents

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For urgent questions, please contact the Claims Administrator Domas Kregždė by phone 8-67865972 or by e-mail domas.kregzde@colemont.lt

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