formular 2 Antragsstrecke 4

Insurance Details and Payment

75%

Your Personal Liability Insurance

Selected Plan:

Your sum insured:

Best Benefit Guarantee:

Tariff Option:

Insurance Company:

Adcuri

Insurance Start Date:

*Please note that processing is guaranteed within 3 working days. Insurance cover can only be guaranteed from the time of processing.

Payment Frequency:

IBAN:

*Please note that only European IBAN's can be accepted

BIC:

Bank Name:

Is the account holder different from the policyholder? Yes No

Please fill in all required fields.

The insurance start date must be in the future.

The entered IBAN is invalid. Please check and try again.