Motor Insurance Claim Form

Some or all of the information which you supply to Mediterranean Insurance Brokers (Malta) Ltd. in connection with this claim, will be held by the Company and may be passed to other insurance companies and insurance associations for underwriting and claims handling purposes and for the fight against fraud.

I/We declare that the above statements are true and correct to the best of my/our knowledge and belief.
I/We have not withheld from the Insurers any information within my/our knowledge connected with this claim.
I/We agree to provide the Insurers with any further information or documentation as may be reasonably required.
I/We understand that the Company is not committed to be liable by the completion of this Claim Form.

I understand that by completing this form the data will be processed by MIB in line with GDPR and hereby consent that this data (including if needed sensitive data as defined in article 9 of GDPR) are used for the purposes of providing your insurance services.

I also understand that it is my responsibility to secure and hold the necessary consent from any employees, beneficiaries or other third parties direct or indirectly involved in the insurance proposal/arrangements and whose data will be processed by MIB and the providers of insurance and ancillary services.