Hoe mogen we je helpen?


In the draft form below, you may enter your personal and insurance details, print off the letter and send it either to us or your current insurer. If the insurance company is not listed, simply state its name and we will do the rest. Please do mention the policy number.

N.B. This web page is (partially) in Dutch, since the English is not availiable (yet). Please feel free to call us (070 388 8820) if you need assistance.

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Dit formulier werd digitaal ingevuld via de website van EVR Insurance Voor zover nodig wordt EVR Insurance hiermee door de aanvrager gemachtigd dit formulier namens hem/haar rechtsgeldig te ondertekenen.