New claim

Assign a claim

Please fill in as much information as you have. No field is mandatory: everything you provide helps us open and handle the claim faster.

Secure form. Your information is sent over an encrypted connection and is only shared with the Criteria Costa Rica claims team and the service providers that deliver it.

A. Client

Client Reference Number

Insurance company assigning the claim

Contact Person

Phone

B. CedentName, address and contact details of the cedent

Cedent

Cedent Reference Number

Cedent Address

Cedent Contact Person

Cedent Contact Person Phone

Cedent Contact Person Email

C. BrokerBroker reference and contact details

Broker Reference Number

Broker Name

Broker Contact Person Phone

Broker Contact Person Email

Broker Contact Person

Broker Address

D. Sub-contractorOnly if a sub-contractor was involved in this claim

Sub-contractor Reference Number

Sub-contractor Name

Sub-contractor Phone

Sub-contractor Email

Sub-contractor Contact Person

Sub-contractor Address

E. Insured

Insured Name

Insured Phone

Insured Email

Insured Address

Insured Contact Name

Insured Contact Phone

Insured Contact Email

Insured Contact Address

F. Claim & Policy Details

Country where loss occurred

Claim Type

Policy Type

Date of Loss

Choose it in the calendar. It is shown as 3rd of June 2026.

Reserve AmountA number, or NA

Currency

Priority

Loss Location

Loss Description

Insurer Reference #

Policy Number

Claimed AmountA number, or NA

Currency

G. Policy DetailsCoverage, deductibles and limits

Name Insured

Effective Date

Choose it in the calendar. It is shown as 3rd of June 2026.

Amount CoverageA number, or NA

Currency

DeductibleA number, or NA

Currency

FranchiseA number, or NA

Currency

AggregateA number, or NA

Currency

Policy document (PDF / photo)One file: PDF, JPG, PNG, HEIC, Word or Excel, up to 4 MB.