Déclaration de sinistre pertes d'exploitation (PDF, 189 KB)
Déclaration de sinistre pertes d'exploitation (PDF, 189 KB)
Déclaration de sinistre pertes d'exploitation (PDF, 189 KB)
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DECLARATION DE SINISTRE<br />
Pertes d’exploitation<br />
Preneur d’assurance<br />
Adresse:<br />
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Numéro <strong>de</strong> police:<br />
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Date du <strong>sinistre</strong>:<br />
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Numéro <strong>de</strong> téléphone:<br />
……………………………………...<br />
E-Mail:<br />
……………………………………...<br />
Personne <strong>de</strong> contact:<br />
……………………………………...<br />
Relation bancaire<br />
Nom / Adresse <strong>de</strong> la banque: ………………………………………………………………………………………….<br />
Titulaire du compte: ...........................…………………………………………………………………………….<br />
Clearing no: ............................................………………………………………………………………………….<br />
Compte no: ..……………………………………………………………………………………….…………………<br />
IBAN no: ...……...……………………………………………………………………………………………………..<br />
Informations sur le dommage matériel<br />
Lieu (indication exacte):<br />
…………………………………………………………………………………<br />
Nom <strong>de</strong> l’assureur incendie:<br />
………………………………………..<br />
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Comment le <strong>sinistre</strong> s’est-il produit? (Cause du <strong>sinistre</strong>):<br />
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HDI-Gerling Industrie Versicherung AG<br />
Dufourstrasse 46, Postfach 521<br />
8034 Zürich<br />
Tel: +41 44 265 47 47<br />
Fax: +41 44 265 47 48
DECLARATION DE SINISTRE<br />
Pertes d’exploitation<br />
Quel objets ont-ils été endommagés?<br />
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Informations sur la perte d’exploitations<br />
Quels départements <strong>de</strong> l’enterprise, ont-ils été fermés respectivement endommagés par le dommage<br />
matériel? De quelle manière?<br />
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Conséquences <strong>de</strong> l’interruption<br />
Sur la production:<br />
Durée approximative <strong>de</strong> l’interruption:<br />
…………………………………………………………………… ………………………………….........…….........<br />
Sur les ventes:<br />
Montant approximatif du <strong>sinistre</strong> <strong>pertes</strong><br />
……………………………………………………………………<br />
d’exploitation:<br />
Sur d’autres fonctions <strong>de</strong> l’exploitation:<br />
………………………………….........…….........<br />
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Sous quels aspects le <strong>sinistre</strong> <strong>pertes</strong> d’exploitations a été évalué?<br />
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HDI-Gerling Industrie Versicherung AG<br />
Dufourstrasse 46, Postfach 521<br />
8034 Zürich<br />
Tel: +41 44 265 47 47<br />
Fax: +41 44 265 47 48
DECLARATION DE SINISTRE<br />
Pertes d’exploitation<br />
Mesures pour atténuer le <strong>sinistre</strong><br />
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Autres assurances <strong>pertes</strong> d’exploitation<br />
Est-ce qu’ils existent d’autres assurances <strong>pertes</strong> d’exploitation? Oui Non<br />
Nom <strong>de</strong> l’assureur:<br />
…………………………………………………………………………<br />
No. <strong>de</strong> police:<br />
…………………………………………<br />
Le soussigné autorise HDI-Gerling à consulter les documents officiels.<br />
Lieu et date:<br />
Signature:<br />
………………………………………………………………<br />
………………………………..<br />
HDI-Gerling Industrie Versicherung AG<br />
Dufourstrasse 46, Postfach 521<br />
8034 Zürich<br />
Tel: +41 44 265 47 47<br />
Fax: +41 44 265 47 48
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