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Magic Pass
Magic Pass

Your Magic Pass

${ ('label.pass_status.' + pass.status) | trans }
${ pass.firstName } ${ pass.lastName }

${ pass.birthdate | formatDate }

${ pass.permissionNumber }

Declare an incident
Votre déclaration a été envoyée le ${ isAlreadySubmitted(pass).createdAt | formatDate } à l'assurance
You have no Magic Pass linked to your account

My contact details

Phone number

Damage

Please fill in this field
Please fill in this field

Attending doctor

Please fill in this field

Confirmation

My contact details
${ selectedPass.firstName } ${ selectedPass.lastName }
${ report.email }
${ report.address }
${ report.zip } ${ report.city }
${ report.state }, ${transCountry}
${ report.phone.number }
Iban : ${ report.iban }
Attending doctor
Dr. ${ report.firstName } ${ report.lastName }
First appointment : ${ report.firstAppointmentAt }
Next appointment : ${ report.nextAppointmentAt }
Damage
Reason for claim : ${ transReason }
Injury : ${ report.injury }
Disease : ${ report.illness }
Date of the event : ${ report.eventAt }
Place : ${ report.eventLocation }
${ report.eventDescription }
${ report.eventRemark }

By sending this form, your claim will be sent directly to Helvetia, which will contact you later. Please note that sending this form automatically blocks your subscription. Please check the veracity of the information provided. Indeed, the process is irreversible and definitive.

In the event that Helvetia does not enter into consideration, the pass will be unblocked.
Please indicate the email address of the person that placed the order last year
Please fill in this field
Please type in a valid email address
Product Quantity Total
${ orderItem.title } ${ orderItem.quantity } ${ orderItem.subTotal | price }
Subtotal ${ $store.state.order.order.subTotal | price }
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