Application Household Contents Insurance

ASKA INSURANCES

Household Contents Insurance

This insurance is intended to cover household contents such as furniture, appliances, electronics and personal belongings at the insured address. Coverage is provided subject to acceptance by ASKA Schadeverzekering N.V. and the applicable policy conditions.
Policyholder

Please provide the personal details of the person applying for this insurance.
Name

First NameLast Name
Telephone number
Date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Type of identification document
Identification number
Email
example@example.com
Residential Address (Policyholder/Applicant)

Street Name & House number

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is the address of the insured contents the same as your residential address?
Address of insured contents

Street Name & House number

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you an existing ASKA client?

Preferred Insurance Start Date

Please select the date on which you would like your insurance coverage to begin.

Please Note
Your selected date is your preferred insurance start date and does not guarantee coverage from that date. Your application must first be reviewed and accepted by ASKA. The effective date of your insurance will be confirmed after approval.
Preferred Insurance Start Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Upload Your ID

Upload a clear copy or photo of your valid identification document. Accepted documents include a passport, driver's license or national ID card (Sedula).
Cancelof
Important Completion and submission of this form does not automatically result in acceptance or insurance coverage. Coverage only starts after written acceptance by ASKA Schadeverzekering N.V. and payment of the premium, unless otherwise confirmed in writing.
ASKA Insurances
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Household Contents Insurance