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Claim form

* Compulsory Fields
Personal data


Representative´s details

(ej: 40965784b)


(You can upload a maximum of 2 files of 2 MB each)
(You can upload a maximum of 2 files of 2 MB each)
Claimant details

(ej: 40965784b)

(In numbers)

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(You can upload a maximum of 2 files of 2 MB each)
Reason for claim


(leave amount blank if not applicable)
(You can upload a maximum of 5 files of 2 MB each)
(You can upload a maximum of 5 files of 2 MB each)
(You can upload a maximum of 5 files of 2 MB each)
(You can upload a maximum of 5 files of 2 MB each)
(You can upload a maximum of 5 files of 2 MB each)

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Personal data

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Representative´s details

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Claimant details

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Reason for claim

Product or service:

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Amount claimed:
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I have read and accept the terms and conditions of the personal data protection policy.
The Claimant states that they are not aware that the matter in hand is being pursued through administrative, arbitral or judicial proceedings.