BMI - Home Form

Property Details

Property type

Usage

Construction type

Year home was built

Built area (m2)

Total area (m2)

Dwelling value

Content value

(include valuables)

Quality construction

Postal code

Municipality

Location

Unoccupied for more than 30 days

Yes

Protective devices (check what applies)

Grills

Armoured or solid door

Monitored alarm connected to private security firm

Monitored smoke detectors and fire alarm

Doorkeeper or security guard on a permanent basis (except countryside homes)

Closed urbanization with controlled access for both pedestrians and vehicles

Policy Holder's Details

Name

e-mail

Phone

Policy Details

Are you currently insured?

Yes No

Insurance company

Years insured

Bonus %

Policy number

Comments