of costs of home emergency assistance services

Personal details of the individual filing the request:

Real property details
Details of the insurance:

Details of the insurance:

Did you contact GLOBAL ASSISTANCE’s roadside assistance centre?

If you were unable to contact GLOBAL ASSISTANCE, please provide the reason why. An explanation of why assistance was not arranged and/or paid in the standard way – that is, by contacting and requesting assistance from GLOBAL ASSISTANCE’s home emergency assistance centre – should be included in the event description.

Event details:

Please, attach to this request the invoice and/or receipt issued by the company that provided assistance services. *