Home Insurance

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Policy Start Date

Date / Time *

Customer Information

Name *

First

Last

Telephone *

Email *

Country *

Address *

Building Information

Year of Construction *

before 1975
1976-1996
1997-2003
after 2003

Construction Type *

Reinforced concrete
Wooden
Ordinary Masonry

Building Value *

Items Value *

Pool Value

Guarantees required *

Smoke
Internal Water
Lightning and Explosion
Bad Niiyetl Movements
Earthquake
Storm
Flood or Flood
Landslide
Pine
Car Shock
Theft

Payment and Delivery

Payment *

Credit card
Advance
Mail Order
Installment

Delivery Method *

Delivered Agents
Home delivery
Delivered Central

THIS INFORMATION FORM OF THE ANSWERS TO QUESTIONS WOULD BE TRUE is CONFIRMED. Any damage to exactly meet our careful not to damage the occurrence of compensation to be insured on the day the fair value of your assets.

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