CALL BACK SERVICE Do you have a question or concern? We would be happy to call you back. Please send us the completed call back form. Your request will be processed in French, German or Luxemburgish. My information The fields marked with * are mandatory and must be completed.Already customer ?*YesNoYour policy or customer number:*I would like to be called back:*Please selectTodayTomorrowOn next MondayOn next TuesdayOn next WednesdayOn next ThursdayOn next Fridaybecause:*Please selectLoss eventOther questionsMy contractbest:*Please selectin the morningin the afternoonCorporate name:Title:*Mrs.Mr.Last name:*First name:*Telephone:*E-mail:* Security check (Anti-robots): *Protection of privacy and data:* I agree that D.A.S. Luxemburg may contact me for the purpose of scheduling appointments, resolving questions as well as concerning the subject "legal expenses insurance". The fields marked with * are mandatory and must be completed. This iframe contains the logic required to handle Ajax powered Gravity Forms.