Insured:
Name:
Sir Name:
Email:
NIF:
Adress:
Town
P.C.:
Province:
Sex:
Male Female
Date of birth:
(day/month/year)
Occupation:
Marital status
Single Married Divorced Widow
Insured risk:
Situation:
Town:
Telephone:
Risk assessment:
Year of building or rebuilding:
m2:
Type of activity:
Building material:
Structure:
Non-combustible Combustible < 30%Combustible > 30%
Building envelope:
Non-CombustibleCombustible < 10%
Roofing:
Combustible Combustible > 10%
Material of false ceiling:
Non-Combustible Non-Combustible > 90%Combustible > 10%
Fire:
Are dangerous products being stored?:
Yes No Which?:
Quantity:
Public fire station:
Less than 15 km awayMore than 15km away
Means of protection:
Fire extinguishers FireplugSprinkler system
Permanent surveillance:
Yes No
Means of protection::
Main door:
Back door:
Windows:
Showcase:
Are the premises protected during the siesta (mid day)?:
Are the being surveyed permanently?:
Do you have exterior protection with alarm? :
Do you have interior volume detection?:
Is there a connection to an security company?:
Are your premises located on the first floor or above?:
Electronic equipment:
Description:
Age:
Amount: