Klik - Life Insurance

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Types of insurance:

ADDITIONAL COVERAGES

Against the consequences of accident

In case of severe illness

In case of surgical procedures

For treatment abroad

Gender:

Male Female

Date of birth:

Insurance duration:

years

Annual investment:

EUR

Doesnt work! 123Annual investment refers to the amount in EUR the client wants to set aside for saving through insurance. Way of payment can be: monthly, quarterly, semi annually, annually.1

123Classic mixed life insurance is a safe form of long-term saving, at the same time providing the financial protection of family in case of death of the insured.4

Name:

Surname:

Personal identification number:

Identity card No.:

Address of residence:

Zip code and city:

Telephone No.:

E-mail for offers delivery:

I read terms and conditions and privacy policy and I agree with them

Thank you for using our service9

We shall collect offers for the life insurance as soon as possible and we shall send them to the indicated e-mail address.10

For the purpose of providing adequate information and in order to enable us to act as your insurance intermediary, please mark the following consents.

I read POWER OF ATTORNEY and I agree with it

I read INFORMATION FOR POLICYHOLDER and I agree with them