Household Insurance

Home » Insurance Free Quotation » Household Insurance

Please fill-in following form

Information about the subscriber

- Title

-

First name (required)

-

Last name (required)

-Your Email (required)

-

Telephone (required)

-

Date of birth (required) dd/mm/yyyy

Information about the premises to be insured

-Address (required) :

-Town where premises are located (required) :

-Town ZIP Code (required) :

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* (required) :

-

Total surface (M²) including garage and cellar(required) :

*Not including bathrooms or kitchen but each room larger than 30m² counts double

Buildings :

-Contents sum insured in Euros (required) :

-

Valuable items in Euros :

On the property to insure, do you have ?

Floor ?

Have you had any claims last two years ?

Additional information

(type your message bellow) :

Please recopy this validation code into the field below captcha

[bws_google_captcha]

Please send me a free, no obligation, quotation based on the above :