Country and region

Address

Location of the property Please select… within built-up areas outside built-up areas within a defined holiday resort

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

Type of use Please select… private use only rooms are partially rented out (indicate weeks per year) pure external rental

Number of weeks per year (for partial rental) Fill in only if rooms are partially rented out.

Type of Insurance Location Please select… Primary residence Second residence Weekend House / Apartment

Building Type Please select… Single apartment Single-family house Two-family house Multi-family house

Building Construction Class Please select… I II III IV V

Is the property unoccupied at times?

Number of days per year unoccupied Fill in only if the property is occasionally unoccupied.

Are there businesses or storage facilities with increased fire risk on the insured property or within 10 meters?

Living area in sqm Floor area of all rooms including hobby rooms; excluding stairs, balconies, loggias, terraces, cellar and storage rooms not used for living or hobby purposes.

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

Determination of the Sum Insured Please select… named by the policyholder Takeover from Previous Insurer flat rate calculation based on living area (e.g. 650 € x sqm or individual arrangement of the insurer) Transfer from Sum Determination Sheet

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

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

Are all house and other entrance doors equipped with security locks with flush-mounted security fittings that cannot be unscrewed from the outside?

Is a VdS-approved intrusion alarm system present?

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

Are waterbeds present?

Aquariums present?

Aquariums – content in liters Fill in only if aquariums are present.

Unauthorized motor vehicles / watercraft present?

Bicycles available?

Replacement value of the most expensive bicycle (Euro) Fill in only if bicycles are present.

Time value of the most expensive bicycle (Euro) Fill in only if bicycles are present.

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

List of items to be insured separately Fill in only if items are to be insured separately.

Additional special and unusual items, not explicitly asked about before?

Description of further special and unusual items Fill in only if special items are present.

Correspondence address in Germany

Is or was there prior insurance?

Previous insurance – Company

Previous insurance – Insurance number

Previous insurance – Expiry

Termination of Previous Insurance made by Please select… Policyholder Insurer

Previously insured risks

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

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

Future desired insured risks

Payment method Please select… by invoice by direct debit

Payment method Please select… annually (1/1) semi-annually (1/2) quarterly (1/4) monthly (1/12)

Is additional insurance coverage desired (e.g., building insurance)?

Type of Desired Additional Insurance Coverage Fill in only if additional insurance coverage is desired.

Other notes, remarks

Date – Customer

Customer's signature