Household contents insurance + electronics protection - safe. Good. Protected Please enable JavaScript in your browser to complete this form.1Insurance details2personal data3Details of your apartment4Bank detailsDesired start of insurance *Insurance coverage begins at 12 noon. You can choose tomorrow's date at the earliest.Living space of your apartment in full square meters *up to 30 m²up to 30 m²up to 40 m²up to 50 m²up to 60 m²up to 70 m²up to 80 m²up to 90 m²up to 100 m²up to 110 m²up to 120 m²up to 130 m²up to 140 m²up to 150 m²up to 180 m²up to 200 m²up to 250 m²up to 300 m²Living space: floor area of all rooms including hobby rooms. Staircases, balconies, loggias, terraces, cellar, storage and floor rooms are not taken into account if they are not used for residential or hobby purposes. Contribution per month0,00 €For the electronics module, there is a waiting period of 2 months from the start of the insurance. *I have taken note and acceptMisrepresentation of living space may result in rejection in the event of a claim. *I have taken note and acceptDeductible for electronic damage *In case of electronic damage, a SB of 10 %, min. 50 EUR. an. If the repair is done via rapairNStore, the SB (0 EUR) does not apply.NextSalutation *Mr.Mr.Ms.Surname *FirstLastStreet *House number *ZIP CODE *City *E-mail *phone *Date of birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920BackNextHow is the apartment used? *Main dwellingsecond home for business purposesAdjacent apartment, e.g. vacation homePlease select whether the apartment is used as a primary residence, a secondary residence for business purposes or as a secondary residence.In which building is your apartment located? *Single family houseApartment houseIs your home unoccupied continuously for more than 120 days per year? *YesNoIf your home is unoccupied continuously for more than 120 days per year, we will need more information from you.Are there or have there been similar contracts or applications? *YesNoif yes, please specify insurance company Has there been any home damage in the last five years?YesNoBackNextPayment The insurance can only be taken out if you give us a direct debit authorization (SEPA direct debit mandate) from an account at a German banking institution.Desired payment method *annual annualsemiannualquarterlymonthlyAccount holder *IBAN *SEPA mandate *I authorize Gothaer Allgemeine Versicherung AG to collect payments from my account by direct debit. At the same time, I instruct my credit institution to honor the direct debits drawn on my account by Gothaer Allgemeine Versicherung AG. This framework mandate relates to all current and future contractual relationships with Gothaer Allgemeine Versicherung AG. Note: I can request a refund of the debited amount within eight weeks, beginning with the debit date. The conditions agreed with my credit institution apply.GDPR consent to contact, product information and data protectionI agree that the companies of the Gothaer Group and, if applicable, an intermediary serving me may contact me by telephone and e-mail for the purpose of providing information about insurance and financial services products and arranging personal consultation appointments. I can revoke my consent at any time without formalities. This can be done, for example, by e-mail to servicevereinbarung@gothaer.de or by telephone on 0221 - 308 91730.Important: Apply for my product selection online without consultation *Yes, I would like to apply for my product selection directly online and waive the need for a pre-application consultation. I understand that Gothaer Allgemeine Versicherung AG and the agent do not assume any guarantee or liability that the product I have selected meets my wishes and individual needs. This may adversely affect the possibilities of asserting a claim for damages due to a breach of the duty to provide advice.Die Informationen in folgendem PDF Dokument sind für Ihre Unterlagen bestimmt. Bitte laden Sie diese herunter und stimmen darunter dem Erhalt zu. Der Vertrag kommt erst zustande, wenn Sie unten den orangenen Button "abschließen" klicken. Erst dann erhalten Sie eine Kopie des von Ihnen gestellten Antrages zum Herunterladen. Herunterladen Customer information and notes on the duty to disclose and waiver of advice *I have downloaded the above PDF document "Declarations and Important Notes". These contain, among other things, instructions on the pre-contractual duty of disclosure, the right of revocation and the waiver of advice. The instructions on the pre-contractual duty of disclosure and the right of withdrawal are an important part of the contract. I make these teachings the substance of my application. I hold myself to my application for one month. My right of withdrawal remains unaffected.Signature * Clear Signature Nach Art. 13 DSGVO möchten wir Ihnen Informationen zur Datenverarbeitung geben. Verantwortlicher für die Datenverarbeitung ist die Gothaer Allgemeine Versicherung AG, Gothaer Allee 1, 50969 Köln, E-Mail info@gothaer.de. Mehr Informationen BackOrder with payment
