Subscription Form

Personal liability insurance

Responsabilité Civile

Personal informations
Additional information

Policy holder

Last name (caps) *

First name *

Gender *

Date of birth *

Place of birth *

Address *

Postal code *

City *

Country *

Date of arrival in Switzerland

Mobile phone *

Private phone

E-mail *

Confirm E-mail *

Nationality *

Civil status

School / University *

Current insurer

School *

Banque

IBAN for reimbursement