of costs of roadside assistance services

Personal details of the individual filing the request:

Vehicle details:
Details of the insurance:

Details of the insured event

Did you contact GLOBAL ASSISTANCE’s roadside assistance centre?

If you were unable to contact GLOBAL ASSISTANCE due to a medical examination and/or treatment, please provide the medical report issued by the health care facility that examined and/or treated you. 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 roadside assistance centre – should be included in the event description.

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