Fillable Proceso de Denuncio Producto Anti-Robo Denunciante

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Proceso de Denuncio Producto Anti-Robo Denunciante

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Proceso de Denuncio
Producto Anti-Robo
Denunciante
Nombre del DENUNCIANTE:
Nombre: Rut:
Dirección:
Ciudad:
Correo electrónico:
Teléfonos de contacto:
¿La persona de contacto es el asegurado? (seleccione la opción)
Si No
Datos del ASEGURADO:
Comuna:
Nombre: Rut:
Teléfonos de contacto:
Datos persona de CONTACTO (solo completar si la respuesta anterior fue NO):
Fecha del siniestro: Hora del siniestro:
Causas del Siniestro (explicar en detalle)/Relato
Pérdidas o Daños generados:
Datos del siniestro
Canal de venta: Fecha de adquisición:
(*) Datos a completar por Bci Seguros
Número de Gestión:
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Proceso de Denuncio Producto Anti-Robo Denunciante

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Completed 28 August 2021

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