Full Name / Company Name

Nationality

ID / NIE / CIF / Passport Number

Date of Birth

Phone

Email

Address

Postal Code

City

Property to be Insured

Cadastral Reference

Type of Property
—Por favor, elige una opción—Ground floor flatMiddle floor flatAttic flatDetached HouseSemi-detached House

Address

Postal Code

City

Year of Construction

Year of Renovation

Built Area (m²)

Ownership Regime
—Por favor, elige una opción—OwnerTenant

Use of Property
—Por favor, elige una opción—Primary ResidenceSecondary Residence

Private Pool?
—Por favor, elige una opción—YesNo

Garden Area?
—Por favor, elige una opción—YesNo

Garden Area (m²)

Solar Panels?
—Por favor, elige una opción—YesNo

Solar Panels Value (€)

Theft Protection

Alarm System
—Por favor, elige una opción—YesNo

Security Door
—Por favor, elige una opción—YesNo

Bars on Accessible Windows
—Por favor, elige una opción—YesNo

Safe
—Por favor, elige una opción—YesNo

Other Protections

Insured Amounts

Building (structure/renovations) (€)

Contents (furniture, electronics, décor) (€)

Valuable Items > €3,000 (art, collections, etc.)

Jewelry IN safe > €3,000

Jewelry OUT of safe > €3,000

Do you own a dangerous dog breed?
—Por favor, elige una opción—YesNo

Current Insurance

Current Insurance Company

Policy Expiration Date

Premium (€)

Additional Comments

I authorize ERSM to prepare an insurance proposal