General Information Questionnaire

Questionnaire

General information

Title *

Mr.

Ms.

First name *

Last name *

Did you have a different last name at birth? *

Yes

Last name at birth? *

Date of birth *

Place of birth *

Country of birth *

Nationality *

Where did you live before you came to Germany? *

Email *

Confirm email *

Phone number

Planned duration of stay in Germany? *

When would you like your insurance to start? *

Do you already have a German address? *

Yes

Street *

House number*

Postcode *

City *

Which German address should be insured? *

If you do not have a German address yet, choose the third option and continue.

Same as above

New address

Not available yet

Street *

House number*

Postcode *

City *

Square meters of living space *

Please provide the square meters of living space of the insured home.

Recommended sum insured

Family status *

Do you need insurance coverage for your partner as well? *

Yes

Married since *

Title *

Mr.

Ms.

First name *

Last name *

Last name at birth *

Date of birth *

Place of birth *

Country of birth *

Nationality *

Is your partner self-employed? *

Yes

Children

Do you have child/ren? *

Yes

How many child/ren? *

Do your child/ren live in the same household as you? *

Yes

Do you need insurance coverage for your child/ren as well? *

Yes

Additional notes