Eurobank Cyprus

Submit a claim

Dear Customers if you wish to submit a claim in respect to the Travel Insurance, please fill out the “Notice of Claim Form” (Pdf link) within 25 days of the incident. Please send the form directly to the email: office@genassist.eu or fax to +357 22 499 830.

Disclaimer

You acknowledge the fact that Eurobank Cyprus (the Bank) will not have any access or will not process any data disclosed to the Gold Assist within the claim form. The Bank does not assume any liability or responsibility in relation to a claim and/or completion of the claim form and/or provision of personal data.

By submitting the form, you agree with the Privacy Notice section of the form.

For further information please contact GenAssist TPA at +357 22 519 211.

Travel Insurance - Visa Classic Debit - View pdf

Travel Insurance - Visa Gold - View pdf

Travel Insurance Policy - View pdf

Please let us know about you

Title:

First Name: * as it appears on your National ID:

Last Name: * as it appears on your National ID:

Father's Name: * as it appears on your National ID:

Email Address:

Mobile Phone Number:

Citizenship:

Cyprus National Identification Number:

Issue Date:

Expiry Date:

Tell us more about you

Some additional details about you

Gender:

Date of Birth:

Place of Birth:

Country of Birth:

Education Level:

Preferred Communication Language:

Business and Financial Profile

Tell us what you do for a living

Employment Status:

Profession:

Former Profession:

Annual Gross Salary (€):

Total Other Annual Income (€) :

Country of Tax Residency:

Are you liable to pay Defence Tax in Cyprus?:

Residential Address Details

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Address Line 2:

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City:

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Product and Services

Are you an existing eBanking User?:

Connect a Debit Card with the account:

Full Name to be Printed on the Card :

* Please use Latin and Capital - maximum up to 26 characters

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Select the Banking Centre most convenient to you

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*Select the Banking Centre location most convenient to you

Eurobank Referral

Have you been referred by a Eurobank Cyprus Employee or an Existing Customer? If yes, please insert their name here:

Marketing Consent

Would you like to give your consent for marketing purposes in order to receive updates or notifications regarding the Bank’s products, services, promotions and offers:

Document Attachments

Please attach the supporting documents

Proof of Identification:

Proof of Identification 2:

Proof of Address :

*Recent Utility Bill (not older than 6 months) - only PDF files are accepted

Proof of Income:

e.g. payslip - only PDF files are accepted

Aknowledgement

I confirm, agree, declare and assume under penalty of perjury or fraud, that I have read, understood and accept the General Terms , the Privacy Notice and the Declaration for my account opening request, and that the information given in this application form to Eurobank Cyprus Ltd (the “Bank”) is true, accurate and complete:

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