Quotation request to replace present life insurance

Quotation Request Replacement Life Insurance

Yes, I would like to receive a quotation request from DefA Finance, regarding the replacement of my present (and more expensive) life insurance, in the assumption that I'm in normal condition and healthy.
Therefore, I fully fill in this request form:

	My Data	My Partner's
Restcapital to insure: See chart in your present contract. Take the capital of the first coming expiry date. Because you already payed till then.	EUR	EUR
Initial insured capital:	EUR	EUR
Actual constant premium: If it changes annually you don't have to fill anything in.	EUR	EUR
Smoker or Non-smoker:
Intrest rate mortgage loan/insurance:	%
Original total duration mortgage loan:	year(s)
Date original mortgage loan/insurance:	(dd/mm/yyyy)
*Original duration to pay the premium:**	year(s)

* : Unique or during 2/3 of the duration of the (mortgage) loan (most common; e.g. during 13 years for a mortgage loan of 20 years) or during the duration of the (mortgage) loan (during 20 years in the same example)

	My data	My Partner's
Surname:
First name:
Date of birth:
Place of birth:
Civil Citizenship:
Sex:
Nationality:

Street:		Number:
Zipcode:		City:
Telephone:
E-mail:
Number Test-Aankoop/test-achats:

So far your personal data, we would like to point out that it's important that this is correct.
As soon as we receive your request we'll process your data and let you know our thorough calculation mentioning if it's opportune to replace and with that the following steps to be taken if so within 72 hours by e-mail.

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Privacy law: The given data can and will be managed only by DefA Finance BVBA and won't be, in any case, given to third party for commercial aims (However, if you decide, after getting this personalised offer, to hand in the request in order to obtain a definite offer, the most important data will be transferred to the mortgager/insurance company). You also have the individual right to look in and correct the data you've given to DefA Finance BVBA. On simple written demand we transfer you the stored data for correction or verification. DefA Finance retains the right to keep their clients posted about possible new initiatives and, evolution of the rate, etc of which we mean it could be useful for the client. If you, for any reason, don't want to receive this any longer, then a simple request (by any means of contact) is enough to stop it. By sending this quotation request you agree with our privacy policy.