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PRIVATE - Risk assessment motor vehicle insurance trailers/motorhomes

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Bitte Kopie Zulassungsbescheinigung beilegen. Bitte pro Kfz separaten Risikoerfassungsbogen ausfüllen.

Registration certificate enclosed

yes

License plate

Manufacturer / Key Number

Type / Key Number

Risk Strength (kW)

Risk Strength (HP)

What type is it?

Trailer

Semi-trailer

Motorhome

andere

What type is it? (other, please describe)

permissible total weight (trailer/semi-trailer) in tons.

Payload (trailer/semi-trailer) in tons

Catchment area (trailer/semi-trailer)

Private Traffic

In-plant transport

Interplant transport

Germany

Europe

Europe including CIS

andere

Catchment area (other, please describe)

Body type (trailer/semi-trailer)

closed box

open box

Tarpaulin, Frame

Tipper

Platform

with charger etc.

Other

Body type (other, please describe)

Yaw Dampening Present

yes

License plate/insurer of the predominantly towing vehicle

permissible total weight (motorhome/caravan) in tons.

Is it an electric or hybrid vehicle?

yes

Are the vehicle's batteries rented?

yes

Relevant only if electric or hybrid vehicle.

Type of Construction (Motorhome)

Alcove Construction

Box Body

teilintegriert

vollintegriert

Roof Type (e.g. GFK, Aluminum Flat Roof, Aluminum Hammer Finish, Durabull, Steel Sheet, Waru Foam Roof ...)

Is the trailer lent out?

yes

Vehicle identification number

Date of First Registration

Date of Registration to Holder / Policyholder

New value (€)

Acquisition value (€)

Is the Vehicle Leased / Financed by Credit?

geleast

kreditfinanziert

Have special equipment been (subsequently) installed in the vehicle?

yes

e.g. navigation device, hi-fi system, parking aid, ramps, cranes, etc.

Special equipment (description and values)

Estimated annual mileage (km)

Current Odometer Reading (km)

Regular and predominant parking location between 10:00 PM and 6:00 AM

Single or Double Garage

Underground garage

Carport

Street

own property

andere

Parking space (other, please describe)

The storage location is

absperrbar

Publicly Accessible

Usage of the vehicle

exclusively private

predominantly private

exclusively commercial

predominantly commercial

Is the Vehicle Recognized as a Business Expense?

yes

Are you entitled to input tax deduction?

yes

Are there any further special and unusual risk situations?

yes

Special and Unusual Risk Situations (Description)

Policyholder (Name)

Gender of policyholder

weiblich

male

Date of Birth of Policyholder

Professional status of the policyholder

Self-Employed

Employee

Civil servant

Public service

andere

Industry of the policyholder e.g. construction industry, tourism, agriculture, chemical industry, etc.

Who is the vehicle owner (according to the vehicle registration)?

Policyholder

anderer

Vehicle owner (if different from policyholder)

Do you own owner-occupied residential property?

yes

Type of Residential Property and Company (if applicable)

Are you a member of an automobile club?

yes

Automobile Club and Since When?

Are there negative entries in credit reporting files?

yes

e.g. Creditreform, Infoscore, SCHUFA, personal insolvency.

Negative entries (more detailed information)

Vehicle User

Policyholders (PH) only

Policyholder and partners

Policyholder and partners and child in household community

Driver group not restricted

Date of Birth of Youngest User

Date of Birth of Oldest User

Participation in accompanied driving (which users?) Please specify which of the listed vehicle users participated in accompanied driving. If none: enter "none".

Date of Policyholder's Driver's License Acquisition

Are trips made to non-European foreign countries?

yes

Duration and countries of trips to non-European foreign countries

License plate of the lead vehicle

Deregistration Date of Previous Vehicle

Second car regulation

yes

If yes, data on previous insurance (3.4) are omitted.

Previous Insurance: Company

Previous Insurance: Contract Number

Termination by

Policyholder

Insurer

Liability no-claims discount (NCD) class

Liability no-claims discount (NCD) year

Partial coverage deductible (€)

Comprehensive Insurance Deductible (€)

Comprehensive Insurance No-Claims Class (NC)

Comprehensive Insurance No-Claims Year

Protection letter in previous insurance

yes

Are the above NCDs a special classification?

yes

Years are transferable.

Previous damages in the last 5 years

none

Damage present

Number, type and amount of prior damages in the last 5 years

Is a seasonal license plate desired?

yes

Duration of seasonal license plate

Desired Insurance Scope (Basic Coverages)

Liability

Partial coverage

Comprehensive Insurance

Protection letter

Liability no-claims discount (NCD) class

Liability no-claims discount (NCD) year

Partial coverage deductible (€)

Comprehensive Insurance Deductible (€)

Comprehensive Insurance No-Claims Class (NC)

Comprehensive Insurance No-Claims Year

Please contact us if you wish to change the insurance coverage.

yes

e.g. conversion from comprehensive to partial coverage, change of use.

How should the consultation be conducted? (if you do not contact us)

Payment method

Account (account number)

Bank Code

Account holder (if different)

Bank

IBAN

No-claims protection

yes

Damage does not affect no-claims class unless insurer is changed.

Mallorca Police (Increase of coverage amount for vehicles rented abroad)

yes

GAP coverage (difference between current value and lease residual value)

yes

Waiver of the Defense of Gross Negligence

yes

Replacement value compensation

yes

Secondary damage from marten bites

yes

Extended wildlife damage clause (collision with animals of all kinds)

yes

Driver accident protection

yes

Passenger Accident Insurance

yes

Foreign Damage Protection

yes

In case of faultless accident abroad, the minimum insurance sums valid in the Federal Republic of Germany are provided.

Protection letter (e.g. breakdown assistance and towing costs)

yes

Workshop binding

yes

Should accumulators, charging cables etc. be co-insured? (Electric or hybrid vehicles)

yes

Other special inclusions

yes

e.g. purchase value compensation, direct settlement, own damage coverage, compensation for depreciation, roof avalanches, braking, operational and breakage damage, extension of natural hazard coverage, rental vehicles abroad, service update.

Other special inclusions (which?)

Is additional insurance coverage desired?

Accident insurance

Traffic Legal Protection Insurance

Transport insurance

Details on additional desired insurance coverage

Other notes, remarks

Bei den Fragen handelt es sich um Fragen über gefahrerhebliche Umstände. Unvollständige oder unrichtige Angaben können den Versicherer zum Rücktritt oder zur Kündigung berechtigen. Die Daten werden ggf. zur weiteren Verarbeitung (z.B. Angebotserstellung, Schadenbearbeitung) an Versicherer und Dienstleister weitergeleitet.

Date

Customer's signature

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