Household Insurance -

Information about the subscriber

- Title

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First name (required)

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Last name (required)

-Your Email (required)

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Telephone (required)

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Date of birth (required) dd/mm/yyyy

Information about the premises to be insured

-Address (required) :

-Town where premises are located (required) :

-Town ZIP Code (required) :

Quality ? Renter Owner Co-owner

If rented ? Furnished Unfurnished

Type of premises ? Appartment House

Do you occupy premises ? Occupant Non occupant

Are the premises left unattended more than 60 days/year (in total)? Yes No

-Number of rooms* (required) :

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Total surface (M²) including garage and cellar(required) :

*Not including bathrooms or kitchen but each room larger than 30m² counts double

Buildings : Less than 10 years old More than 10 years old

-Contents sum insured in Euros (required) :

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Valuable items in Euros :

On the property to insure, do you have ? Outdoor furniture Swimming pool Fire detectors A fire place

Floor ? Ground Intermediary floor Top floor

Have you had any claims last two years ?Yes No

Additional information

(type your message bellow) :

Household Insurance