Skip to main content
Claim notification
Kieli
*
- Select a value -
Suomi
Englanti
Ruotsi
Laji
*
Details of the insured
First name
*
Surname
*
Sex
*
- Select a value -
Male
Female
Identity number/Date of birth
*
ID of the insured
*
Seura
*
Name of the team
*
Level of league
N/A
Liiga tai ykkönen
Kakkonen tai kolmonen
Nelonen tai alempi
If you play the adult classes, which is the series level?
Address
*
Postcode
*
Post office
*
Country
Telephone number
*
Email address
*
Team Representative, team leader or coach
First name
*
Surname
*
Address of the team representative
Post number of the team representative
Post office of the team representative
District
Club
*
Team of the representative
*
Phone number of the representative
*
Email address
*
Are you the team representative mentioned before?
This field is required only if ...
Details of the accident
The date of the accident (pp.kk.vvvv)
*
*
Date
E.g., 03.12.2024
Syötä tähän päivämäärä, jolloin vahinko on sattunut
The marked information is for Football Association of Finland, and are collected to develop game- and practice circumstances and training programmes
*
Did the accident happen outdoors?
*
Ei
Kyllä
Place where the accident took place
*
- Select a value -
At the game
At the practice game
At the practices
On the way from the game/practices
On the way to the game/practices
Location of the accident
*
Address of the place where accident occurred.
*
Surface
*
- Select a value -
Surface
Natural grass
Artificial grass
Artificial grass with sand filling
Artificial grass with rubber chips
Sandfield
Other
Vamman sattumisalusta muu
*
Weather conditions
*
- Select a value -
Rain
Snowfall
No rain
If the injury occurred outside, what was the weather conditions/soil/temperature?
Soil
*
- Select a value -
Dry
Hard
Dry and hard
Watery and hard
Muddy
Icy
Temperature
*
- Select a value -
-15°C or less
-14°C - -3°C
-2°C - +2°C
+3°C - +14°C
+15°C or more
Type of injury
*
- Select a value -
Sprain (ligament)
Injury because of overstraining
Contusion
Distension (muscular injury)
Fracture
Dislocation
Other
Vamman tyyppi muu
*
Mikäli muu vamman tyyppi, mikä
Injured body part
*
Jalkaterä
Nilkka
Sääri
Polvi
Reisi
Nivus
Selkä
Pää/kasvot/niska
Hammas
Käsi
Muu
Injured body part(s).It is possible to choose several items
Vamman kehonosa muu
*
In case of other part of the body, what/which
(kidneys, chest, stomach etc.)
Injured side
*
Oikea
Vasen
Molemmat puolet
Has the same part of the body been injured before?
*
Rule violation
*
- Select a value -
No
Yes, due to my own action
Yes, due to someone else`s action
Did the accident occur due to a rule violation
Severeness of the injury
*
- Select a value -
Insignificant, absence less than one (1) week
Moderate, absence from one (1) week up to four (4) weeks
Serious, absence more than four (4) weeks)
Severeness of the injury
Attachments
Add a new file
Files must be less than
10 MB
.
Allowed file types:
txt pdf csv xml jpg jpeg png gif doc docx odt odf ppt
.
Information about medical treatment and clinic
Contractual clinic
*
Ei
Kyllä
Medical clinic
- None -
Arte-Lääkärit
Bulevardin klinikka
Helsinki Hospital
KristinaMedi
Lääkärikeskus Aava
Lääkärikeskus Ikioma
Medipori
Mehiläinen
Pihlajalinna
Pikkujätti
Pohjola Sairaala
Promedi
Terveystalo
Hoitopaikka mikäli ei sopimuslääkäriasemalla
The date of the care (dd.mm.yyyy)
Date
E.g., 03.12.2024
Doctor´s name
Claim cost specification
Expenditures of doctor´s fee, specification
Order
Definition
Date
Date
E.g., 03.12.2024
Cost
Receipt
Files must be less than
10 MB
.
Allowed file types:
txt pdf csv xml jpg jpeg png gif doc docx odt odf ppt
.
Weight for row 1
-1
0
1
Expenditures of examinations, specification
Order
Definition
Date
Date
E.g., 03.12.2024
Cost
Receipt
Files must be less than
10 MB
.
Allowed file types:
txt pdf csv xml jpg jpeg png gif doc docx odt odf ppt
.
Weight for row 1
0
Expenditures of medications
Order
Definition
Date
Date
E.g., 03.12.2024
Cost
Receipt
Files must be less than
10 MB
.
Allowed file types:
txt pdf csv xml jpg jpeg png gif doc docx odt odf ppt
.
Weight for row 1
0
Expenditures of service charge, specification
Order
Definition
Date
Date
E.g., 03.12.2024
Cost
Weight for row 1
0
Expenditures of invoicing charge, specification
Order
Definition
Date
Date
E.g., 03.12.2024
Cost
Weight for row 1
0
Travelling expenses, specification
Order
Definition
Date
Date
E.g., 03.12.2024
Cost
Receipt
Files must be less than
10 MB
.
Allowed file types:
txt pdf csv xml jpg jpeg png gif doc docx odt odf ppt
.
Weight for row 1
0
Other
Order
Definition
Date
Date
E.g., 03.12.2024
Cost
Receipt
Files must be less than
10 MB
.
Allowed file types:
txt pdf csv xml jpg jpeg png gif doc docx odt odf ppt
.
Weight for row 1
0
Claimant`s information
Claimant is:
*
Vakuutettu
Seuran / Joukkueen edustaja
Muu
Claimant's first name
Claimant's last name
Claimant's social security number
Address of the claimant
Post number of the claimant
Post office of the claimant
Country of the claimant
Phone number of the claimant
E-mail of the claimant
Did someone help you to fill this damage report form?
*
Ei
Kyllä
Avustajan tiedot
Avustajan etunimi
Avustajan sukunimi
Avustajan henkilötunnus
Avustajan lähiosoite
Avustajan postinumero
Avustajan postitoimipaikka
Avustajan maa
Avustajan puhelinnumero
Avustajan sähköpostiosoite
Compensation information
Account number (IBAN)
In case of international account number
BIC code
Give the BIC-code (the bank´s id-code)
Further clarification
Has claim been applied/ will be applied from another insurance company?
*
Ei
Kyllä
From what company?
I accept the terms
*
I will allow those with the necessary information concerning the claims settling to give that information about me and my medical condition to Vektor Claims Adiministration. Vektor Claims Administration can vouchsafe information concerning a filled notification of claim to the insurance joint data system. The data are used in accordance with the permit conditions imposed by the Data Protection Board only to prevent crime against insurance companies.
Vertical Tabs