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Legal Insurance Proposal Form for BFG/ NATO customers

Taking out legal insurance with Culpeck Insurance Broker means that you will hold cover with a long- established, very professional English/ German speaking company with the highest standard of insurance cover on today's BFG/ NATO market.

A legal case is a dispute between opposing parties resolved by a court, or by some equivalent legal process and can be either civil or criminal. In every case there is always a defendant and an accuser. Regardless on which side you might find yourself, in the event of a juridical discrepancy taking out insurance cover with our underwriters 'Roland Rechtschutz' means you can be assured to minimize any financial risks, even if the case does not work out in your favour.

Just a few selling points:

• No excess
• Solicitor free of choice
• Sum insured: 1 Mio. Euros
• 200.000,- Euros for bailment on loan
• 24 hour customer helpline, including juridical advice
• One vehicle for 60€   |   All vehicles for 82€   |   Private & Traffic for 218€   per year.

Personal Details
Salutation: Mr. Mrs. Miss. Ms. Dr.
Date of birth:	/ /
BFPO/ Unit address:	Postal address:*(n/a if same as unit)
Telephone number:*
Email address:
Nationality:	Albania Belgium Bulgaria Canada Croatia Czech Republic Denmark Estonia France Germany Greece Hungary Iceland Italy Latvia Lithuania Luxembourg Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Turkey United Kingdom United States 'OTHER'
Married, engaged or do you have a life- partner?	Yes No
Spouse's name:
Spouse's date of birth:	/ /
Cover Required
Preferred start date: / /
Payment Options
Yearly Semi-Annual Quarterly Monthly
Direct Debit:	yes   no
Name of German bank institute	Sort-Code (BLZ)	Account No. (Konto)
I am not a client of Culpeck Insurance Broker...
...but I am seeking new insurance*
...as my policy is due for renewal*
For Culpeck clients only
I wish to change my insurance company*
My policy is due for renewal/ I would like Culpeck to check my premium*
*optional
Remarks/ Additional information
Is this form understandable and easy to complete?	Yes Yes, but still room for improvement NO!!!