Please enter your First Name and Last Name and correspondence adress

First name*

Second name*

Two-part last name should be separated by space.

ID number

Street*

House number*/Apartment number

Postal code* -

City*

Telephone number*

E-mail*

Select the address where the phone is to be collected

Correspondence address Other

First name*

Second name*

Street*

House number*/nr lokalu

Postal code* -

City*

Select the address where the phone is to be returned

Correspondence address Other

First name*

Second name*

Street*

House number*/Apartment number

Postal code* -

City*

Do you need a loan unit in case the repair takes longer than expected?

It refers in which you are entitled to receive a replacement device for an extended repair time.

Yes No

Please select the type of device that is damaged

Phone

Smartphone

Tablet

Laptop

Other device

Please provide the following additional information about the damaged device

Brand*

Make*

IMEI/SN*

If you want to chceck your IMEI number you can do it by dialing *#06# on your phone or you can find it under battery. The serial number (SN) can be found on the serial sticker of the device or on the original box

Date of purchase*

purchase price*

Have you previously exchanged your device under the manufacturer's warranty?

Yes No

Brand*

Model*

IMEI/SN*

Date of replacement*

What has happened to your device?
Damage report is possible by phone:
Helpline (22) 716 20 06, open from 9 a.m. to 6 p.m.

When did the damage occur?

Damage Date*

Event City*

Enter the name of the town where there has been damage to your device.

Event Country*

Enter the name of the country where there has been damage to your device.

Please describe how the damage occured

The circumstances of damage*

Please indicate which parts of the device have been damaged

Do you have the insurance contract number?

Yes No

Please enter your policy number*

Please enter the date your policy commenced*

Under what program are you reporting damage?

Please select a program

DALEJ

Statements

I hereby give my consent to receive commercial information electronically to the specified e-mail address or telephone number. *

I have read and agree to the Terms and Conditions for the repair of mobile devices, in accordance with the insurance option choosen by me. *

I consent to the processing of my personal data in compliance with the General Data Protection Regulation (GDPR) (EU) 2016/679 for the purposes of handling my inquiry submitted via the contact form. Any personal data so provided will be processed only during the period necessary to resolve the problem presented in the form. *

SUMMARY

*To go to the next step, fill in all required fields

Please fill in correct ID Number

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Claim Request

Please enter your First Name and Last Name and correspondence adress

Select the address where the phone is to be collected

Select the address where the phone is to be returned

Do you need a loan unit in case the repair takes longer than expected? It refers in which you are entitled to receive a replacement device for an extended repair time.

Please select the type of device that is damaged

Please provide the following additional information about the damaged device

Have you previously exchanged your device under the manufacturer's warranty?

What has happened to your device? Damage report is possible by phone: Helpline (22) 716 20 06, open from 9 a.m. to 6 p.m.

When did the damage occur?

Please describe how the damage occured

Please indicate which parts of the device have been damaged

Do you have the insurance contract number?

Under what program are you reporting damage?

Statements

Please fill in correct ID Number

Oops. Try to add more details.

Thank you for submitting your claim online

Oops. Something goes wrong. Please try later.

Do you need a loan unit in case the repair takes longer than expected?

It refers in which you are entitled to receive a replacement device for an extended repair time.

What has happened to your device?
Damage report is possible by phone:
Helpline (22) 716 20 06, open from 9 a.m. to 6 p.m.