Formular 1 Antragsstrecke 3

Questionnaire

50%

Your Personal Liability Insurance

Selected Plan:

Your sum insured:

Best Benefit Guarantee:

Tariff Option:

Insurance Company:

Adcuri

Personal Information

First Name: Last Name:

Birthdate:

Do you have a German address? Yes No

If you do not currently have a German address, we can temporarily use our companies c/o address.
In this case, please inform us of your German address as soon as it is available.
Your insurance will still be active from your desired insurance start date onwards.

Gender:

Email Address:

Did you have a liability insurance policy in Germany in the last five years? Yes No

Please fill in all required fields.