Registration insurance



I would like to register for the theft and fire insurance. I agree to the monthly service charge increase of € 1,20 or € 2,40 when it concerns a combi-home or an AIO-apartment.
Name:
E-mail adress:
Adress:
Number: (corridor + roomnumber:)
Commencement date:as soon as possible
 on:
 
Comments: (please notify if it's a combi-home or appartement in connection with the double insurance)