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PRIVATE - Risk assessment holiday properties

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Personal Data Fully Known - Data Entry Not Required

yes

Title, academic degree

Name

First name

Address

ZIP code City

Date of Birth

Birth Name

Place of Birth / Nationality

Occupation

Professional status

Country and region

Insurance location address

Location of the property

within built-up areas

outside built-up areas

within a defined holiday resort

Type of use

private use only

Rooms are partially rented out

pure external rental

Partial rental: approx. weeks per year Fill in only if partially rented out

The insurance location is

Primary residence

Second residence

Weekend House / Apartment

Building Type

Single apartment

Single-family house

Two-family house

Multi-family house

Building Construction Class

Construction Class I (Walls: Stone, Roofing: Tiles)

different construction type

Different construction type (e.g. prefabricated houses, wood, slate roof, etc.) Fill in only if construction type differs

Year of construction

Is the property unoccupied at times?

yes

Property temporarily unoccupied: approx. days per year Fill in only if temporarily unoccupied.

Is the building located less than 500 meters from a flowing body of water or a coast?

yes

Are there operations or storage facilities with increased fire risk within less than 10 m distance?

yes

Living area in sqm Floor area of all rooms including hobby rooms, excluding stairs, balconies, terraces, and cellar and attic rooms not used for residential/hobby purposes

Usable area in sqm

Replacement value of the building or condominium in a community facility (€)

Additional building components to be insured with new values Please list building components with their respective new values.

Determination of the Building’s Replacement Value

Sum Insured of Entire Household Contents at New Replacement Value (€) Note: If the sum insured significantly deviates from the actual insured value, the insurer may reduce the compensation.

Determination of the Household Contents Sum Insured

Valuables share of the insured sum in % e.g. collections, artworks, jewelry, furs, gems

Share of electronic devices in the insured amount in % Electronic devices to be insured against overvoltage

Are security locks with non-removable, flush-mounted security fittings on all house and entrance doors present from the outside?

yes

VdS-approved burglar alarm system present?

yes

Mehrwandiger Stahlschrank (> 200 kg) oder eingemauerter Tresor mit mehrwandiger Tür vorhanden?

yes

Are waterbeds present?

yes

Aquariums present?

yes

Aquariums: total content in liters Fill in only if aquariums are present

Unauthorized motor vehicles / watercraft present?

yes

Bicycles / E-bikes / Pedelecs available?

yes

Replacement value of the most expensive bicycle (€)

Time value of the most expensive bicycle (€)

Total new value of all bicycles (€)

Is a full comprehensive bicycle insurance desired?

yes

Household items located outside the insured premises for more than 3 months

yes

Storage location of household items stored off-site for more than 3 months

Garage

Garden Shed

sonstiges

Total value of outsourced household goods (€)

Risk location of outsourced household items

Distance to the apartment (m)

Type of Household Goods Stored There

Are items regularly left in the vehicle?

yes

Items regularly left in the vehicle (type, value, etc.)

Items to be insured separately (e.g. cameras, musical instruments, hunting or sporting weapons, sports equipment, camping gear, etc.)

yes

Additional special and unusual items present, not previously asked about?

yes

Description of further special and unusual items

Correspondence address in Germany

Is or was there prior insurance?

yes

Previous Insurance: Company

Previous Insurance: Policy Number

Previous Insurance: Expiry

Termination of Previous Insurance made by

Risks Insured in Previous Insurance

Fire, Water Damage, Storm, Hail

Burglary Theft, Robbery

Natural hazards

All-Risk

Glass breakage (building and furniture glazing)

Glass breakage (ceramic cooktop)

Previous damages in the last 5 years (natural hazards 10 years), including uninsured

none

yes, see details on number, type and amount

Information on number, type and amount of prior damages

Future desired insured risks

Fire, Water Damage, Storm, Hail

Burglary Theft, Robbery

Natural hazards

All-Risk

Glass breakage (building and furniture glazing)

Glass breakage (ceramic cooktop)

Payment method

Is additional insurance coverage desired (e.g., glass insurance, homeowner's liability insurance)?

yes

Details on further desired insurance coverage

Was the property inspected by the broker or an expert?

yes

Date of Property Inspection

Further details on the property inspection

Other notes, remarks

Bei den Fragen handelt es sich um Fragen über gefahrerhebliche Umstände. Unvollständige und unrichtige Angaben zu den gefahrerheblichen Umständen berechtigen den Versicherer, im Falle der vorsätzlichen oder grob fahrlässigen Verletzung der Anzeigepflicht, vom Versicherungsvertrag zurückzutreten. Wird die Anzeigepflicht vorsätzlich oder grob fahrlässig verletzt, hat der Versicherer das Recht, den Vertrag innerhalb eines Monats ab Kenntnis von der Anzeigepflichtverletzung unter Einhaltung einer Frist von einem Monat zu kündigen. Diese Daten werden ggf. zur weiteren Verarbeitung (z.B. Angebotserstellung, Schadenbearbeitung etc.), wie in der "Einwilligungserklärung zur Datenverarbeitung" beschrieben, an Versicherer und Dienstleister weitergeleitet.

Date (Signing)

Customer's signature

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