Risk location

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Building Type According to Scheme (1.1 without Basement / 1.2 with Basement) ? Please select the applicable building type. The associated value of 1914 per sqm of living space in Marks (M) results from the selection.

Value 1914 per sqm living space (building type, number 1) ?

Surcharges (2.1) – Construction types / fittings ? The associated surcharges are specified in Marks (M) per sqm of living space.

Deductions (2.2) – Simpler Construction Executions / Equipment ? The associated deductions are specified in Marks (M) per sqm of living space.

Total surcharges (2.1) in Marks (M) per sqm of living space

Total Deductions (2.2) in Marks (M) per sqm Living Area

Sum of values 1914 according to items 1 and 2 ?

Value 1914 per sqm living space (number 3) ?

4.1 Living Area Attic Living area attic in sqm.

4.2 Living area upper floor Living area upper floor in sqm.

4.3 Ground floor living area Living area ground floor in sqm.

4.4 Subtotal living area (ground floor + upper floor + attic) Subtotal of living areas according to items 4.1–4.3 in sqm.

4.5 Living area basement floor Living area basement floor in sqm.

4.6 Living area (total) Total living area in sqm.

Living area according to section 4.4 (sqm)

Value 1914 per sqm living space according to number 3 (M)

Subtotal insured amount 1914 (living area × value 1914 per sqm) Result of multiplication of living area (item 4.4) × value 1914 per sqm (item 3) in Marks (M).

Living area basement according to section 4.5 (sqm)

Surcharge for basement living area expansion (15 M per sqm) Living area basement (sqm) × 15 m.

Garages / Carports outside the residential building Garages / Carports outside the residential building are included in the insurance sum 1914 as a lump sum.

Sum Insured 1914 (Overall) Final insured sum 1914 in Marks (M).

Date

Signature applicant/policyholder