Intermediary
Notification of a Data Breach concerning Europäische Reiseversicherung AG
1. Identifier Details
Employee Number (Y-Number)
Legal Entity you are assigned to
Department
First Name
*
Surname
*
E-Mail address
*
Company Telephone
*
2. Breach Details
Notification Date
Personal Data typology
Name
Address
Date of birth
E-mail
Financial Details
Health Data
Policy Information
Insurance/claims details
Others
Number of individuals impacted by the breach (if known)
(Please specify a numeric value)
Breach Classification
Unauthorized disclosure of customer or employee personal data
Loss of mobile end devices (mobile phone, notebook, USB-Stick)
Burglary attempt
Malware
Access to data by unauthorized persons
Others
Data Breach details
*
Cause of the Breach
Human error
Process failure
System issue
Unknown
Others
Impacted Legal Entity
Impacted Department
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