General Information Questionnaire

General Information - Insurance Application

Title *

Mr.

Ms.

First name *

Last name *

Did you have a different last name at birth? *

Yes

Last name at birth? *

Date of birth *

Place of birth *

Country of birth *

Nationality *

Where did you live before you came to Germany? *

Planned duration of stay in Germany? *

When would you like your insurance to start? *

Email *

Confirm email *

Phone number

Do you already have a German address? *

Yes

Street *

House number*

Postcode *

City *

As you are also interested in household contents insurance, please provide the address to be insured: *

Same as above

Enter new address

Street *

House number*

Postcode *

City *

Square meters of living space *

Please provide the square meters of living space of the insured home.

Recommended sum insured

Family status *

Do you need insurance coverage for your partner as well? *

Yes

Married since *

Title *

Mr.

Ms.

First name *

Last name *

Last name at birth *

Date of birth *

Place of birth *

Country of birth *

Nationality *

Is your partner self-employed? *

Yes

Do you have child/ren? *

Yes

How many child/ren? *

Do your child/ren live in the same household as you? *

Yes

Do you need insurance coverage for your child/ren as well? *

Yes

Additional notes