Mortgage Life Insurance
Information Concerning the First Person
Information Concerning the First Person
Information Concerning the Second Person
Information Concerning the Second Person
INFORMATION CONCERNING THE MORTGAGE OR LOANS YOU WISH TO INSURE
Please send us the banks offer or proposal if you already have it.I
THE FINANCIAL DETAILS
ADDITIONAL REQUIREMENTS
SIGNATURE
FIRST PERSON
SURNAME
FIRST NAME
DATE OF BIRTH
PLACE OF BIRTH
NATIONALITY
FULL ADDRESS (main place of residence)
TELEPHONE
HAVE YOU SMOKED OR VAPED IN THE LAST 24 MONTHS?
HEIGHT (cms)
WEIGHT (kgs)
JOB TITLE
EMPLOYER
INDUSTRY
DO YOU TRAVEL OUTSIDE OF YOUR HOME COUNTRY FOR WORK?
If YES, please state frequency and countries
DO YOU HAVE ANY HEALTH ISSUES?
If YES, please detail
DO YOU ALREADY HAVE FRENCH LIFE INSURANCE?
If YES, please advise which companies you hold policies with and amounts insured
DO YOU PRACTICE SPORTING ACTIVITIES CONSIDERED TO BE DANGEROUS EITHER FOR PLEASURE OR COMPETITIVELY?
If YES, please provide details
SECOND PERSON
SURNAME
FIRST NAME
DATE OF BIRTH
PLACE OF BIRTH
NATIONALITY
FULL ADDRESS (main place of residence)
TELEPHONE
HAVE YOU SMOKED OR VAPED IN THE LAST 24 MONTHS?
HEIGHT (cms)
WEIGHT (kgs)
JOB TITLE
EMPLOYER
INDUSTRY
DO YOU TRAVEL OUTSIDE OF YOUR HOME COUNTRY FOR WORK?
If YES, please state frequency and countries
DO YOU HAVE ANY HEALTH ISSUES?
If YES, please detail
DO YOU ALREADY HAVE FRENCH LIFE INSURANCE?
If YES, please advise which companies you hold policies with and amounts insured
DO YOU PRACTICE SPORTING ACTIVITIES CONSIDERED TO BE DANGEROUS EITHER FOR PLEASURE OR COMPETITIVELY?
If YES, please provide details
MORTGAGE or LOAN INFORMATION
TOTAL MORTGAGE AMOUNT
TYOE OF MORTGAGE (interest only, capital repayment, bridging loan)
INTEREST RATE & DURATION
BANK & BRANCH
CONTACT PERSON
TELEPHONE & EMAIL
FIRST PERSON
AMOUNT TO BE INSURED PER BORROWER (% of loan)
RISK REQUIRED (if known – DC/PTIA or DC/PTIA + ITT/IPT)
ESTIMATED DATE INSURANCE NEEDS TO BE IN PLACE FOR
PROPERTY ADDRESS
TYPE OF PURCHASE (ie 2nd home, rental)
SECOND PERSON
AMOUNT TO BE INSURED PER BORROWER (% of loan)
RISK REQUIRED (if known – DC/PTIA or DC/PTIA + ITT/IPT)
ESTIMATED DATE INSURANCE NEEDS TO BE IN PLACE FOR
PROPERTY ADDRESS
TYPE OF PURCHASE (ie 2nd home, rental)
ADDITIONAL REQUIREMENTS
WOULD YOU LIKE US TO OPEN A FRENCH BANK ACCOUNT FOR YOU?
WOULD YOU LIKE TO OBTAIN A QUOTE FOR HOME INSURANCE FROM US?
DO YOU HAVE ANY OTHER FRENCH INSURANCE REQUIREMENTS WE CAN HELP YOU WITH?
WOULD YOU LIKE TO RECEIVE MORE INFORMATION ON CURRENCY?
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