The Insurance Verification Form is a crucial document used in the Belgian insurance market to provide formal confirmation of insurance coverage and related details. This document is typically required when parties need to demonstrate proof of insurance to third parties, such as financial institutions, business partners, or regulatory authorities. The form, governed by Belgian Insurance Law and EU regulations, includes essential information about the policy holder, coverage details, and specific verifications required under Belgian insurance regulations. It serves multiple purposes, from satisfying regulatory requirements to facilitating business transactions, while ensuring compliance with both insurance regulations and data protection laws. The Insurance Verification Form is designed to be comprehensive yet clear, providing all necessary information while maintaining compliance with Belgian legal requirements and GDPR provisions.
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1. Applicant Information: Essential personal/company details of the party requesting insurance verification, including full name, address, and contact information
2. Insurance Policy Details: Key information about the insurance policy being verified, including policy number, type of coverage, and effective dates
3. Insurer Information: Details of the insurance company, including legal name, registration number, and contact information
4. Coverage Verification: Specific details about the coverage being verified, including coverage limits, deductibles, and any specific endorsements
5. Declaration: Statement confirming the accuracy of information provided and authorization for verification
6. Data Protection Notice: GDPR-compliant statement about how the provided information will be processed and stored
7. Signature Block: Space for authorized signatures, dates, and official stamps where required
1. Additional Insured Parties: Section for listing any additional parties covered under the policy, used when multiple entities are involved
2. Claims History: Section for declaring previous claims, used when historical verification is required
3. International Coverage: Details of coverage in other jurisdictions, used for policies with cross-border elements
4. Broker Information: Details of the insurance broker, used when the policy was arranged through an intermediary
5. Payment Verification: Section confirming premium payment status, used when payment verification is specifically required
1. Schedule A - Coverage Details: Detailed breakdown of specific coverage elements and limits
2. Schedule B - Supporting Documentation Checklist: List of required supporting documents for verification
3. Appendix 1 - Terms and Conditions: Standard terms and conditions for the verification process
4. Appendix 2 - Privacy Notice: Detailed GDPR-compliant privacy notice explaining data processing practices
5. Appendix 3 - Authorization Forms: Additional authorization forms required for specific types of verification
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