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PRIVATE - Risk assessment multi-family house (private)

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1. Personal Data Fully Known - Data Entry Not Required

Title / academic degree

Name

First name

Address

PLZ

City

Date of Birth

Birth Name

Place of Birth / Nationality

Occupation

Professional status

Soweit die Hauptgebäude eines Risikoortes unterschiedlichen Versicherungsschutz, Baujahre, Bauartklassen und/oder Nutzung haben, je Gebäude separaten Bogen aufnehmen. Soweit der gewerblich genutzte Teil über 50 % beträgt, bitte Risikoerfassung "Komposit Gewerbe - Mehrfamilienhaus" bzw. "Komposit Gewerbe - Betriebsgebäude" nutzen.

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

yes

Address of the risk location (if different)

Ownership Statuses

Building Designation / Site Plan Designation

Year of building

Sanierung bedeutet, die Bausubstanz wurde vollständig wiederhergestellt und in neuwertigen Zustand versetzt.

Last complete renovation of the potable water and heating installation (year)

Last complete electrical installation renovation (year)

Last complete renovation of the roof (year)

Roof Type

Flat roof

Gable roof

Pitched roof

Are advertising installations mounted on the building?

yes

Total area (sqm)

Private/Residential Area (sqm)

Private/Residential Share (%)

Commercially Used Area (sqm)

Commercial Share (%)

Number of residential units

Number of commercial units

Hinweis zur Wertermittlung: Die Wertermittlung erfolgt nach Wohnfläche und Ausstattungsmerkmalen (nur für Ein- und Zweifamilienhäuser der Bauartklassen I und II oder Fertighausgruppen I und II, die ausschließlich Wohnzwecken dienen). Wohnfläche ist die Grundfläche einer Wohnung, einschließlich Hobbyräume; ausgenommen sind Treppen, Kellerräume und Speicherräume (soweit nicht zu Wohn- und Hobbyzwecken ausgebaut), Balkone, Loggien und Terrassen. Nebengebäude, Schwimmbäder, weiteres Zubehör und sonstige Grundstücksbestandteile sind gesondert zu bewerten und werden bei dieser Berechnung nicht erfasst. Sofern der Gebäudetyp nicht eindeutig zuzuordnen ist, ist der überwiegende Gebäudetyp zu wählen.

Basement - Living area (sqm)

Basement - Commercial area (sqm)

Basement - Type of operation

Ground floor - residential area (sqm)

Ground floor - commercial area (sqm)

Ground floor - type of operation

Number of upper floors

Upper floor(s) - total living area (sqm)

Upper floor(s) - total commercial area (sqm)

Upper floor(s) - type of business

Attic - Living Area (sqm)

Attic - Commercial Area (sqm)

Attic - Type of Operation

Is Construction Class 1 (Solid Walls, Hard Roofing) Present?

yes

Information on construction type (if construction class 1 not applicable)

Type of heating

Location of the oil tanks (for oil heating)

Capacity of oil tanks (liters)

Year of heating system

Last heating inspection

Information on gas heating / other heating type

Should existing or new annexes and extensions be included with a flat rate of up to 20%?

yes

The insured value must be included in the total insurance sum. Year of construction, construction type, and usage may differ from the main building.

Description of outbuildings and annexes (if to be insured)

Sollen besonders zu versichernde Gebäudebestandteile in den Versicherungsschutz aufgenommen werden, welche in den Deklarationen nicht pauschal mitversichert sind?

Tiled Stove - Value (€)

Tiled Stove - Year of Construction

Terrace - Value (€)

Terrace - Year built

Swimming Pool - Value (€)

Swimming Pool - Year Built

Sauna - value (€)

Sauna - year of construction

Whirlpool - value (€)

Whirlpool - year of construction

Sprinkler System - Value (€)

Sprinkler System - Year Built

Air Conditioning - Value (€)

Air Conditioning - Year of Manufacture

Built-in Furniture - Value (€)

Built-in Furniture - Year of Construction

Built-in Kitchen - Value (€)

Built-in Kitchen - Year of Construction

Conservatory - value (€)

Conservatory - year of construction

Alarm System - Value (€)

Alarm System - Year of Manufacture

Rainwater cistern - value (€)

Rainwater cistern - year of construction

Heat pump - value (€)

Heat pump - year of construction

Solar system - value (€)

Solar system - year of construction

Photovoltaic System - Power (kWp)

Photovoltaic System - Value (€)

Photovoltaic System - Year of Construction

Underfloor heating - area (sqm)

Underfloor heating - value (€)

Underfloor heating - year of construction

Rainwater pipes inside the building - description

Should particularly insurable property components be included in the insurance coverage?

yes

Particularly to be insured are especially artworks outdoors, elaborate open space facilities, elaborate advertising installations. Please note that pipes outside the buildings are not automatically insured.

Description of property components to be specially insured

Sum Insured Including Outbuildings - Value 1914

Sum Insured Including Outbuildings - New Replacement Value

Sum insured including outbuildings - current value

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).

Determination of the Sum Insured

Security confirmation required?

yes

Lender (if security confirmation required)

Insured risks

Fire

Tap water

Storm / Hail

Natural hazards

EC a (civil commotion, malicious damage, strike or lockout)

EC b (vehicle impact, smoke, sonic boom)

unnamed hazards

Glass Insurance

Desired deductible (€)

Include rental loss insurance for

yes, for owner-occupied residential rooms

yes, for rented residential rooms

yes, for commercially used rooms

Gross Annual Rental Value for Residentially Used Share (€)

Gross Annual Rental Value for Commercially Used Share (€) not applicable, no commercial use

Hazard Increases / Specially Agreed Matters Present?

yes

e.g. businesses with increased fire risk closer than 10 meters to the insured building, building is vacant, energy generation systems (photovoltaic, air conditioning, heat pumps), swimming pool, underfloor heating, sprinkler system, historic preservation

Further details on increased hazards / special circumstances

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

yes

Note: Observe Obligations.

Certificate of Inspection dated (date)

Is there structural or organizational fire protection?

yes

e.g. fire alarm or sprinkler system, own fire brigade, security, fire protection regulations, certification, fire protection or alarm plan, etc.

Additional information on structural / organizational fire protection If applicable, please attach documents/proofs.

Is or was there prior insurance?

yes

Previous insurance - Company

Previous insurance - policy number

Previous insurance - expiration

Termination of Previous Insurance made by

Reason for Termination (if by insurer)

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

none

yes, pre-existing damages present

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

Payment method

Requested payment frequency

Was the property inspected?

yes

Date of Property Inspection

Further details on the property inspection (e.g., by whom)

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 weder vorsätzlich noch 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.

City

Date

Customer's signature

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