Household contents insurance application personal information

Questionnaire

Personal Information

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Insurance Details and Payment

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Summary

Household Contents Insurance

Insurance Provider: Adcuri

Plan

Premium

Living Space

99 m²

Sum Insured

69966 €

Glass Cover

Not included

10.84 €

130.08 € per year

Personal Information

First Name: Last Name:

Gender:

Nationality:

Birthdate:

Postal Code:

City:

Street:

House Number:

Is the address above the one to be insured? Yes No

Email Address:

Have you had household contents insurance in Germany in the past three years? Yes No

Please answer this question.

Please fill in all required fields.

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