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Detalle diseño

Description of the Insured Risk

1. Mortgage Do you have a mortgage?
     No    Yes

2. About the insured risk Address Postal code City/town State/county

3. Type of building VThe building is built of fireproof materials, such as brick, cement, iron and others with similar charasteristics.

4. Premises/ Home Insured Building area (m2) House type Building year House use

5. Security components
Alarm connected to the Security System Service

Sums Insured

Dwelling replacement value (€  ) Furniture (€  ) Jewelry (€  )

Policy holder

Name First Name NIF/CIF or passport number Birth date      
Address City or Town Postal Code Country
E-mail Telephone

Effective date

Effective date        

El responsable de tratamiento de sus datos personales es Riesgos Especiales Correduría de Seguros SA con la finalidad de contratar el seguro sin ceder datos a terceros que, salvo obligación legal, no sean entidades aseguradoras. Tiene derecho a acceder, rectificar y suprimir los datos, como se explica en la información adicional en garantía de Privacidad.
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