Credit-life insurance

Secure forms

*Required information

Applicant

Surname
First name
Gender
Smoker
Date of birth (dd/mm/yyyy)
Your Weight (Kg)
Your Size (cm)
Office phone
Email

Spouse or co-applicant

Surname
First name
Gender
Smoker
Date of birth (dd/mm/yyyy)
Your Weight (Kg)
Your Size (cm)
Office phone
Email

Address and no.
Postal code
Town
Home phone
Mobile number
Test-Achats membership number
Are you already a VDV CONSEIL client?

Note

Some insurers have personalised (experience) rates which take into account even more criteria; these rates sometimes turn out to be the best on the market. We must therefore be provided with information that you could perhaps deem intrusive. If you answer the following questions, we will be able to take these into account in our search for the best rate.

Applicant

Educational level, qualification(s)
Occupation
Net monthly income
Member of a sports club? If yes, which one?
Sports played

Spouse or co-applicant

Educational level, qualification(s)
Occupation
Net monthly income
Member of a sports club? If yes, which one?
Sports played

LOAN FEATURES

Applicant

Capital amount borrowed
Capital to be insured for which applicant is responsible
Name of lending company
Life of mortgage loan (in years)

Spouse or co-applicant

Capital amount borrowed
Capital to be insured for which co-applicant is responsible

Is there a need to take into account a capital repayment holiday period (in months) (only at the end of this period will you begin to pay back the amount borrowed. In other words, you do not pay back any capital but only the interest during this period). Furthermore, is this capital repayment holiday period included in the total duration of the contract mentioned hereinafter, or does it need to be added over and above?

Capital repayment holiday period ( in months )
Must it be added to the duration of the contract above?
Annual interest rate for the mortgage loan
Mortgage loan repayment method

Applicant

Frequency of insurance premium
Desired effective date (dd/mm/yyyy)

Spouse or co-applicant

Frequency of insurance premium
Desired effective date (dd/mm/yyyy)

Note

In the case where you have taken out a tailored loan (reduced monthly payments at the start, for instance), you will need to send us the loan's amortisation schedule.

Comments if any

This information is given on a confidential basis; you may however authorise us to use your e-mail address to be kept informed on developments and promotions at VDV Conseil.

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