If you consider that your problem has not been satisfactorily resolved through the usual channels, please fill in all the fields on this form; otherwise we will not be able to process your claim correctly. We will acknowledge receipt within a maximum of 3 working days.

Complainant's details

Complainant's status

Specify your relationship to the policy

Representative (to be completed only when the claim is submitted through a representative)

Address for notifications

Insurance details

Reason for complaint or claim

Explain clearly what the matter is about which the complaint or claim is being made.

Intended outcome of the complaint or claim

Declaration and consent

The claimant hereby states that the issues raised in the claim have not been the subject of litigation or challenge before the courts of law, nor are they pending resolution by an administrative, arbitration or judicial body.

For the purposes of the provisions of the current Personal Data Protection regulations, the claimant consents to the personal data provided being included by Saint Clement Claims Management And Recovery Services S.L. in a file, and to its subsequent processing, as its completion is required in order to process the claim presented, being the recipient and party responsible for the file Saint Clement Claims Management And Recovery Services S.L., with address at C/ Gobelas 21, 1º Derecha, 28023 Madrid, where the claimant may exercise the rights of access, rectification, cancellation and opposition to the processing of these, by writing to the attention of the Legal Representative.