Household insurance quotation

Title

First name

Last name

e-mail*

Phone

Date of birth (dd/mm/yyyy)

Address*

Town where premises are located*

Town ZIP Code*

Quality *

If rented ?*

Type of Premises*

Do you occupy premises ?*

Are the premises left unattended more than 60 days/year (in total)?*

Number of rooms*

Total surface (Square meters) including garage and cellar*

Building construction date*

Contents sum insured in Euros*

Valuable items in Euros*

On the property to insure, do you have ?

Outdoor furniture

Swimming pool

Fire detectors

A fire place

Floor list?

Have you had any claims last two years ?

You can ad any additional info bellow

Veuillez saisir les caractères*

Cela nous aide à éviter les spams, merci.

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Quotation form for household insurance