Zurich Versicherung Aktiengesellschaft (Deutschland)
Protracted Default – Notice of Non Payment
Policyholder: Policy No.: ZK No.: Customer name and address:
Please be informed that the above mentioned customer has not made the following payment:
Invoice(s) Collection procedures and measures already taken a) Reasons for non-payment b) Are payments being disputed? c) Which measures have been taken to secure payment and collect receivables? d) Which futurer measures do you propose to take?
Date of invoice(s)
Due date of invoice(s)
Amount of invoice(s) GBP EUR
total amount:
We hereby declare that to the best of our knowledge and belief, the information given above and attached herewith is true and correct in every respect. We confirm that all documents relating to this claim are available for claims assessment if required.
Date
Authorised Signatory
Zurich Versicherung Aktiengesellschaft (Deutschland) · Direktion Frankfurt Solmsstraße 27-37 · 60252 Frankfurt am Main/Germany · Phone +49 69 7115-0 · Fax: +49 69 7115-3530 · www.zurich.de Bank identifikation code: IBAN DE11 500 400 00 0580 650 002 SWIFT (BIC) COBADEFFXXX, Commerzbank AG, Frankfurt am Main/Germany Chairwoman of the Supervisory Board: Annette Court. Management Board: Eduard Thometzek (CEO), Andreas Bruckner, Dr. Bernd Dedert, Manfred Florian, Rüdiger Hackhausen, Dr. Marita Kraemer, Jens Lison, Dieter van Loo, Arnulf Loy, Josef Marx, Dr. Rolf G. Niemann, Axel Schmitz, Jürgen Schulz, Dr. Jochen Schwarz, Jörg Wälder. Registered Office: Frankfurt am Main/Germany (HRB 41176).
218220122 0802
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