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Obrazac Albe Koja Se Upucuje Pravobraniteljstvu 7
Obrazac Albe Koja Se Upucuje Pravobraniteljstvu 7
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Ime i prezime (naziv) podnositelja žalbe: Mjesto i datum:__________________
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Martićeva 71
Zagreb
1. Broj predmeta pod kojim se postupak prethodno vodio/vodi kod osiguratelja: ______________
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3. Razlog za podnošenje žalbe, činjenični pregled i zahtjev
(najprije kratko navesti razlog za podnošenje žalbe a potom kronološki prikazati važne činjenice i
okolnosti te istaknuti zahtjev podnositelja žalbe, a to znači sažeto opisati kakav učinak podnositelj
želi postići žalbom)
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PRILOZI/DOKAZI
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U interesu stranke je da žalbi priloži sve dokaze kojima potkrepljuje činjenične navode, u prvom
redu odnosnu policu osiguranja (ako postoji i ako je dostupna), dokaz o obraćanju osiguratelju radi
rješavanja spora u internom postupku, relevantne odluke osiguratelja, eventualne isprave drugih
nadležnih tijala (npr. policijski zapisnik, zapisnik o očevidu isl.), fotografije itd. Dovoljno je priložiti
obične preslike isprava, nije potrebno prilagati izvornike isprava niti njihove ovjerene preslike.