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POLICY HOLDER DETAILS
Full Name* :
Address of Property (to be insured) :
Date of Birth :
Your Occupation :
Email Address :
Telephone :
Country code:
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Number:
Owner or Tenant?
Owner
Tenant – furnished
Tenant – unfurnished
If tenant, is the property rented out furnished?
Yes
No
Main Residence?
Yes
No
Are you already insured in France? If so, with which company and for how many years?
Have you had any claims in the past 3 years? (Type, responsibility, was a third party involved?) :
Has your insurance been cancelled by the insurance company in the past 36 months?
Yes
No
When does your insurance need to start?
When was the property built?
Type of habitation (house, flat, mobile home, caravan, chalet)
HOUSE DETAILS
Do you have a swimming-pool?
Yes
No
Do you have Solar panels, a heat pump or a Windmill?
Yes
No
Do you have an alarm system installed?
Yes
No
Please list all rooms and sizes
Rooms less than 9m² are not counted
What are the measurements of the outbuildings?
(barns, garage … not connected to the main building)
Value of Contents (without valuables) :
Euros
Value of Valuables :
(jewelry, gems, natural pearls and solid precious metal objects each with a value above 300€)
Euros
EXTRA OPTIONS
Excess for damages, glass breakage €0
Excess for damages, glass breakage €140
Excess for damages, glass breakage €280
New for Old
Gite/chambres d'hôtes
Outdoor facilities
Do you need school insurance?
Yes
No
Are you interested in the legal assistance cover?
Yes
No