Policyholder

Consultation by

Personal Contact Person

Does the address of the risk location differ from the policyholder's address?

Different address of the risk location

Are additional risk locations present and should they be co-insured? Note: If you change the insurance location or add new insurance locations, coverage for these only exists after confirmation by the insurer.

Additional risk locations (address and proportional insured sums)

Type of operation

Commercial Area Size (in sqm)

Are insurable items present that cannot be assigned to the above-mentioned business type and should be co-insured?

Items to be insured outside the business type (please specify insurance sums)

Are the following insurable items present? Jewelry, Spirits, Leather, Fur, Smoke and Alcantara Goods, Tobacco Products, Photo/Film Articles, Communication Electronics, Fashion Jewelry, Oriental Carpets, Consumer Electronics, Precious and Non-Ferrous Metals. Please specify insurance sums.

Items to be insured listed below (include value)

Are insurable items present that are usually not insured under business contents insurance (e.g. motor vehicles, (tenant) fittings, vending machines) and should be co-insured?

Usually Uninsured Items (Further Explanations)

Is one or more of the following risk increases present? E.g., buildings with combustible exterior walls and/or soft roofing, certain neighboring businesses, sprinkler system, storage of supplies less than 12 cm above the floor in rooms below ground level.

Hazard Increases (detailed explanations)

Are all exterior doors secured with flush cylinder locks (minimum security)?

Are minimum safety devices installed if not currently present?

Further requirements for burglary protection

Further requirements for burglary protection (details if listed below)

Is the respective test certificate for the electrical systems available for fire insurance?

Test Certificate of Electrical Installations (Date)

Are there any further special and unusual risk situations that have not been explicitly asked about so far?

Special and Unusual Risk Situations

Desired risks (business contents insurance)

Is additional glass breakage insurance desired?

Total glass area (sqm)

Area of the largest single panes (sqm)

Is Special Glazing Present?

Type of special glazing

Desired Calculation Scope (Total Annual Net Amount)

Total insured sum for property insurance (EUR) Note: If the sum insured significantly deviates from the insured value according to contract terms, the insurer is entitled to reduce the compensation accordingly (underinsurance).

Should items and sums be increased or decreased deviating from the insurer's declaration?

Different items and sums (e.g. external insurance, items outdoors, cleanup costs, etc.)

Requested general deductible (EUR)

Which business interruption insurance is desired?

Sum Insured for Business Interruption Insurance (EUR)

Liability period for business interruption insurance

Liability period (other months)

Should the following items be included in the business interruption insurance (documents/data carriers, additional costs, consequential damages)?

Items to be additionally insured in business interruption insurance (with desired sum insured)

Is extended insurance coverage for fixed and current assets desired (e.g., transport, technical insurance, business interruption, business buildings)?

Requested further insurances / review of existing insurance coverage

Is or was there prior insurance?

Previous insurance - Company

Previous insurance - policy number

Previous insurance - expiration

Termination made by

Number and amount of prior damages in the last 5 years (elementary 10 years) - including uninsured

Previous damages in recent years (number, type, and amount)

Have countermeasures been taken following damages?

Countermeasures after Damage (description)

Requested payment method

Requested payment frequency

Other notes, remarks

Date (Signing)

Customer's signature