Home Insurance Quote - Staging and Testing

Section 1 — Your Information

Last Name *

First Name *

Date of Birth *

Phone Number *

Email *

Street Address of the Property *

Additional Address Details

Postal Code *

Property owned through a SCI or SARL? *

Section 2 — Your Property

Type of Property *

You are *

Type of Residence *

If Apartment — Floor

If Apartment — Total Floors in Building

If Apartment — Cellar/Basement?

If Apartment — Terrace/Balcony?

If House — Number of Levels

If House — Year of Construction

If House — Outbuildings?

If House — Outbuildings Area (m²)

If Secondary Residence — Seasonal Rental?

Section 3 — Property Characteristics

Living Area (m²) *

Rooms > 7m² *

Rooms > 30m² *

Rooms > 40m² *

Year of Construction *

Unoccupied > 60 days/year? *

Special Features

Section 4 — Equipment & Security

Fireplace? *

Swimming Pool? *

Spa / Jacuzzi? *

Alarm System? *

Remote Monitoring? *

Safe? *

Reinforced Doors with Multi-Point Locking? *

Shutters or Window Protections? *

Smoke Detector? *

Section 5 — Value of Insured Assets

Furniture & Personal Belongings — Total Estimated Value (€) *

Jewellery, Valuables, Artwork, Wine, etc. — Total Estimated Value (€) *

Section 6 — Claims History

Claims declared in the past 3 years? *

Any insurer ever cancelled your policy? *

If Yes — Date of Claim

If Yes — Type of Claim

If Yes — Approximate Amount (€)

Section 7 — Deductible

Desired Deductible Amount (€) *

Section 8 — Desired Effective Date

Desired Policy Start Date *

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