1. Identification of the policyholder
First Name
Family Name
1.2. Date of birth
Place of birth
1.3 Nationality
Nationality 2
Nationality 3
1.4. Mailing address
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.
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1.6. Email
Phone
Phone
1.7 Your current home insurance statut
A : You just arrived /or you are arriving in Luxembourg
B : You are taking your first home insurance in Luxembourg
C : You are already insured in Luxembourg and would like to change your intermediary
D : You are already insured in Luxembourg and would like to change to a new insurer
.
A : From which country
A : Arrival date in Luxembourg
.
C-D : Name of your current insurer / contract number
C-D Estimation of how much you pay per year
2. Description
2.1.. Mailing address
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.
.
2.2. 5. Do you have outbuildings at another address (garage, etc.)
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.
a). If YES, address
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b). Describe the outbuildings
2.3. Home / outbuildings type
House
Residence
Apartment
Studio
Chalet,
Mobile home
Garage
Risk location
The whole building
Apartment - Ground Floor
Apartment - Intermediate Level
Apartment - Top floor
Property under construction
2.4. Construction year
Construction Type
Master house
Listed Home
Traditional – Masonry more than 10 years old
Contemporary – Class A masonry
Contemporary – Class B masonry
Contemporary – Class C/D/Other masonry
Prefab or Class A Timber Structure
Prefab or Class B Timber Structure
Prefab or Wood Structure Class C/D/Other
No Idea
2.4. Energy performance class
A
B
C
D
E
F
G
H
I
I don't know
2.5. Neighborhood
Distant building less than 100m,
Isolated building at more than 100m
Located in a flood-risk area
Number of free facades of the building
3 Description du risque
3.2. 1. How many persons ( adults / children) at home
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3.3.Residence type
Main residence
Secondary residence
Leased
Unoccupied +120 days
Quality of the holder
Tenant
Free occupant
Occupant Owner
Non-Occupant Owner
Occupant Co-owner
Non-Occupant Co-owner
.Monthly rent (charges included)
.Effective date of the lease contract
3.4. Building & Content to be insured
Building alone
Content alone,
Building + Content
New for old replacement (content)
4. Estimate: Insurance of the building based on the developed area (house, garage) / the number of rooms (apartment)
Surface area of other permanent building used as a shed (m2)
Total number of main rooms (including verandas, winter gardens, sports halls, mezzanines, ...) and of less than 30 m² (except bathrooms, toilets, halls, corridors, and rooms under 8m²)
5. Estimate: Building insurance based on capital (chalet, caravan, etc.)
5.1. Amount insured
6. Amount insured (occupant and non-occupant)
Building (Occupant / Non Occupant
Building improvement (occupant)
Effect of condominum (Non-occupant)
Furniture & contents (occupant/Non occupant)
Object of value (occupant/non-occupant)
7. Couvertures
General basic included garanties
      ■ Fire and related cover This cover applies in the case of damage caused to the building or insured contents.
      ■ Attacks & public demonstations, vandalism and damage to property : for damage to your home's external walls, including graffiti.
      ■ Storms, hail, weight of snow and ice on roofs if a storm or hail damage to your home and insured contents...
      ■ Water damage and frozen pipes This cover insures you for damage to your insured building and contents.
      ■ Broken glass or mirrors in case of accidentally broken windows
      ■ Costs, losses and liabilities costs of temporary closure of the building, excavation and demolition, furniture storage, cleaning,... in case of any fire, storm, water damage,...
      ■ Home assistance : You may need help following a claim (finding new accommodation, cover for your children and pets, cover if you need to return early from holiday, …)
7.2.Additional garanties to include
• Natural disasters Covers material damage caused to the insured building and contents following overflowing sewers, earthquakes, floods, land collapses, ….. • Private liability insurance It is important to cover any accidental injury or damage to other people items, by youself or other members of your household… it covers damage caused to the 3rd party. • Criminal defence and civil actions Defence in legal proceedings following an incident relating to your liability. Legal assistance against a third party who has caused bodily injury or damage to your items. • Theft, acts of vandalism, acts of malice you are insured for both stolen and damaged property. • Portable items Your smartphones, tablets, laptops, games consoles, cameras and lenses, GPS and connected objects, as well as helmets and watches, are all covered. (The insured amounts can be tailored to meet your needs: light, medium high) • Electronic items Your television, your computer, your Dolby surround system… Your home automation devices like your robotic vacuum cleaner or food processor, …., are covered against breakage, damage or impact! (The insured amounts can be tailored to meet your needs: light, medium high) • Green energies for convinced ecologists: renewable energy installations such as photovoltaic panels, heat pumps, geothermal systems • Legal cover A dispute following an online purchase? A contractual dispute with a repairer? Conflict with your employer? • Personal accidents Accident when playing sport, falling on the stairs or burning yourself in the kitchen… • Travel Repatriation assistance, medical costs, cancellation or changes to travel plans and luggage insurance.. • Leisure items and assistance Your bikes, drones, hoverboards, golf equipment, ….. are insured for theft or even breakage, impacts or falls! • Valuables and collections Your jewellery, your collections and your fashion accessories and handbags are covered
Comments
8. Questions
8.1. In your previous home insurance, have you already had claims? If yes, explain?
8.2. Have you been declared bankrupt or in compulsory liquidation? If yes, explain
8.3. Have you already contacted another intermediary / insurer (agent, broker) for the current process?
If so, which insurers have already been contacted?
8.4. Do you have any other insurance (car, healthcare, pension ….) with an insurance in Luxembourg.?
If so, which insurer / Contract do you have?
8.5. PROMO CODE (Aurels Luxembourg) or NAME of your Aurels Advisor
9. You are requested to send us (if necessary)
1) A copy of your ID card
2 ) A copy of your curent homer insurance
3) Any other document you find useful
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