BAI - Claim

Claims Form

Field the form below to ensure your claim's treatment efficiency and quality.

*Mandatory fields

Full Name*

Are you a BAI customer?*

Yes No

Enter the account number

Phone Number*

Email*

Incident desk*

Is it the first time that you suggest on the same subject?

Yes No

Date

Subject*

Reason*

Select

Complaint Description

0/1000 characters

Clean