YOUR DETAILS
Name and first name
Place of residence
Mail address
Telephone or mobile number
National number
DETAILS OF THE BUILDING
The complete address of the building
Type of property ?
You take this insurance in the capacity of ?
Is this your principal residence ?
Should the insurance include motor vehicles ?
Does it concern a building under construction or the purchase of a building ?
What age has the building ?
Questions concerning the number of rooms in the building. Please mention all the rooms, except the hall and the rooms with a surface less than 4m²:
Living area(s)
Separate kitchen(s)
Bathroom(s)
Sleeping room(s)
Veranda(s)
Other finished room(s)
Only for liberal professions :
Total number of rooms that you use for your profession
Parking spaces and annexes
Possible parking spaces in the main building or annex
Possible parking spaces under the carport
The total surface of the other annexes (e.g. garden house, glasshouse, shed,…) ?
The total surface of the outdoor swimming pool ?
Questions concerning the finishing of the building :
Is there a fence to the street side (with a height > 1m) ?
Does the main building have a thatched roof (no roofing tiles or flat roof) ?
Are there floors in the building in natural stone, massif parquet, wood or are there cast floors present ?
Does the kitchen have a worktop in natural stone, composite, inox or ceramic? Or does the kitchen have more than 6 built-in appliances ?
Are at least two outer walls completely made out of natural stone ?
Is domotica (‘domotique’) installed in the building ?
Does the main building include a cellar ?
Do you have solar panels ?
What is the total floor area of the largest (living) room ?
If any, what age has the heating oil tank ?
Natural disaster-related questions (flood and earth quake):
Has there been damage as a consequence of floods to the building in the past 10 years ?
During the past 10 years, losses as a consequence of floods always remained limited to the cellar ?
During the past 10 years, losses as a consequence of floods did only once not remain limited to the cellar ?
During the past 3 years, has there been water damage to the home ?
Should the insurance include burglary ?
Is there an INCERT approved alarm system present, fitted by a certified installer ?
In case of an apartment, please indicate :
The entire building is insured in a syndic policy
The apartment is located entirely above the ground floor
How much is the total surface area of the apartment ?
OTHER
Optional : to the attention of
Questions or remarks




Arents & Partners Verzekeringen BVBA

Albertlaan 220, 9400 Ninove

T. 054 32 95 41

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FSMA 042591 A

KBC logo

Verbonden agent, FSMA 042591 A, van KBC Verzekeringen NV, Professor Roger Van Overstraetenplein 2, 3000 Leuven, België BTW BE 0403.552.563, RPR Leuven, IBAN BE43 7300 0420 0601.

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