Quotation request life insurance

Quotation request form life insurance

Yes, I would like to receive a quotation request from DefA Finance, regarding a life insurance, in the assumption that I'm normal and healthy.
Therefore, I fully fill in this request form:

	My Data	My Partner's
Capital to insure:	EUR	EUR
Intrest rate (mortgage) loan:	%
Duration (mortgage) loan:	year(s)
*Duration wanted to pay the insurance premium:**	jaar

* : Unique or during 2/3 of the duration of the (mortgage) loan (most common; e.g. during 13 years for a mortgage loan of 20 years) or during the duration of the (mortgage) loan (during 20 years in the same example)

	My Data	My Partner's
Surname:
First name:
Date of birth:
Place of birth:
Civil Citizenship:
Sex:
Smoking behaviour:
Nationality:

Street:		Number:
Zipcode:		City:
Telephone:
E-mail:
Number Testaankoop/Test-achat:

So far your personal data, we would like to point out that it's important that this is correct.

As soon as we receive your request we'll process your data and let you know our best calculation within 72 hours by e-mail.
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Privacy law: The given data can and will be managed only by DefA Finance BVBA and won't be, in any case, given to third party for commercial aims (However, if you decide, after getting this personalised offer, to hand in the request in order to obtain a definite offer, the most important data will be transferred to the mortgager/insurance company). You also have the individual right to look in and correct the data you've given to DefA Finance BVBA. On simple written demand we transfer you the stored data for correction or verification. DefA Finance retains the right to keep their clients posted about possible new initiatives and, evolution of the rate, etc of which we mean it could be useful for the client. If you, for any reason, don't want to receive this any longer, then a simple request (by any means of contact) is enough to stop it. By sending this quotation request you agree with our privacy policy.