QUOTE APPLICATION FORM: Personal Liability:

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Do you give Finkor consent to share your personal information, in order to prepare insurance quotations for you? *

Surname, Brith names & Title: *

ID nr *

Celphonen Nr: *

EMAIL *

Occupation: *

Pensioner *

Marital status: *

With whom are you currently insured with? *

Your current premium? *

Address: *

Area Kode: *

Did you experience any losses in the last 7 years? *

If so, please specify below

1: Date

1: Section

1: Circumstances

1: Amount

2: Date

2: Section

2: Circumstances

2: Amount

3: Date

3: Section

current Circumstances last

3: Circumstances

3: Amount

PERSONAL LIABILITY:

Insured Amount

Finkor