Consultation & quote for home insurance

    Contact information

    Are you the homeowner?:

    What is your use of the home?:

    How many persons reside in the dwelling?:

    The house

    Is it currently insured?:

    Is it mortgaged?:

    What type of home do you want to insure?:

    Where is the property located?:

    What is the quality of the construction?:

    What materials is it made of?:

    Has the property been rehabilitated?:

    If yes, indicate in which year:

    Protection Systems

    Grilles on all openings and windows:

    Grids only on the first floor:

    Built-in safe:

    NO built-in safe:

    Armored doors with security bolt with 3 anchor points?:

    Armored windows?:

    Alarm system at all entrances?:

    Alarm system only on the first floor?:

    Permanent 24h surveillance?:

    Other protection systems?:

    Container and content data

    Indicate when you plan to take out or renew your policy:

    Indicates date of birth of the policyholder or holder:

    Is the policyholder in any delinquency file?:

    Indicates the place of birth of the policyholder:

    If you wish, you can attach your ID card, passport or current household policy in PDF (maximum 4MB) for data verification.

    In accordance with the provisions of the current legislation on the Protection of Personal Data, you are informed that the personal data you provide through this form will be processed by Campussing, in order to manage your request and send you more detailed information.For more information, please consult the PRIVACY POLICY.

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