Complete the form below and one of our specialist advisors will prepare a tailored loan insurance quote for you.
Last Name *
First Name *
Date of Birth *
Occupation *
Employment Status *SelectEmployedSelf-employedCivil servantRetiredUnemployedStudent
Phone Number *
Email *
Type of Employment Contract *SelectPermanent (CDI)Fixed-term (CDD)Freelance / Self-employedCivil servantOther
Length of Employment (years with current employer) *
Gross Annual Income (€) *
High-Risk Occupation? *SelectYesNo
Type of Project *SelectProperty purchaseRenovationRefinancingConstructionOther
Loan Amount (€) *
Outstanding Capital (€) *
Loan Term (years) *
Interest Rate (%) *
Bank *
Insured Percentage (%) *
Loan Signature Date *
Type of Loan *SelectFixed rateVariable rateInterest-onlyOther
Desired Coverages *
Desired Deductible (€) *
Height (cm) *
Weight (kg) *
Ongoing Medical Treatment? *SelectYesNo
Hospitalization in the Last 5 Years? *SelectYesNo
Chronic Illness? *SelectYesNo
Smoker? *SelectYesNo
Long-Term Medical Condition (ALD – Affection de Longue Durée)? *SelectYesNo
Do You Practice Any High-Risk Sports? *SelectYesNo
Frequent Travel Outside the European Union? *SelectYesNo
Aviation Activities / Diving / Motorcycling? *SelectYesNo
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