Personal Information

Surname

First Name

Address

Postcode

City

Country

Email

Telephone

Birthday

Age

Place of Birth

Country of Birth

Gender

Male

Female

Prefer not to say

Status & Background

Employment Status

Marital Status

Number of Children

Current Insurance Provider

Health Information

Do you have any existing medical conditions? **

Yes

No

Please specify your medical condition(s)

** We need to know this because some health insurers charge a risk fee or decline your application

For NON-EU Citizens Only

Do you have a current valid Residence Permit?

Yes

No

If YES, how long is your permit valid?

If NO, do you have an appointment at the immigration office? When?

Insurance Requirements

Type of Insurance Interested In

Health Insurance

Pension & Protection Plans

Liability & Legal Protection

Property & Living

Travel Insurance

Pet Insurance

Specific Insurance Name (if known)

Preferred Contact Method

Following are voluntary questions

Do you have a liability insurance (Haftpflichtversicherung) in Germany?

Yes

No

Do you want a good offer from us for liability insurance?

Yes

No

Do you have a household contents insurance (Hausratversicherung) in Germany?

Yes

No

Do you want a good offer from us for house-hold insurance?

Yes

No

Do you have a pension-plan insurance (Rentenversicherung) in Germany?

Yes

No

Do you want a good offer from us for pension-plan insurance?

Yes

No

Do you have a legal insurance (Rechtsschutzversicherung) in Germany?

Yes

No

Do you want a good offer from us for legal insurance?

Yes

No

Contact Preferences

Need Advice on Insurance?

Yes

No

Insurance Enquiry Form