Réalisez jusqu'à 50 % d'économies sur l'assurance de votre prêt !
Notre offre assurance de prêt
Demande de devis
Mieux comprendre
Contacts Nos partenaires
C : COURTAGE
Votre spécialiste en assurance de prêt
H
A
B
I
T
A
T
Loan Insurance
(
L nI Senior 2
Seniors
)
Loan Insurance from age 60
Subscription application - 2005/2006 F o r loans of E7,500 to E310,000 R e d u c e d medical formalities S u b s c r i p t i o n possible from age 60 (up to age 80) " B o n u s " ser v i c e s : removal and works and Remote monitoring
assurances
A P R I L A s s u r a n c e s b y yo u r s i d e
APRIL Assurances designs, manages and distributes simple and innovative insurance solutions, manages them with constant emphasis on reactivity and quality, and distributes them via a network of independent insurance consultants. With ISO 9001 version 2000 certification for its personal insurance design and management activities, APRIL Assurances puts customer satisfaction at the heart of its commitments.
A wide range of solutions
Highly diversified, they enable APRIL Assurances to offer a response to the widest possible range of insurance requirements : family, employees, borrowers, seniors, directors, the self-employed, students, travellers.
Providence Health insurance and individual providence solutions.
Phone
Loan insurance and credit offer solutions.
Phone
Health insurance and providence solutions for companies, protection for company directors.
Phone
0 891 46 9000
0,23inc . VAT/min
0 891 46 6000
0,23inc . VAT/min
04 72 36 75 35
· 94% of people insured are satisfied with APRIL Assurances* products and services, · 96% of our insurance consultants would recommend APRIL Assurances to a colleague**.
In 2005 APRIL Assurances entres Top 25 compagnies "Best places to work" in France.
APRIL Assurances subsidiaries
Saving, retirement and defiscalization solutions.
International insurance solutions.
Automobile and home insurance solutions.
Key facts
· APRIL Assurances founded in 1988, · Division of APRIL GROUP, listed on the Paris bourse (SBF 120), · Almost 1 million people insured individually or through their employers, · 550 staff, · 1 ,400 independent insurance consultants. 1
Your Insurance Consultant
C: COURTAGE 17 Villa du Petit Parc 94000 CRETEIL Tél. : 01 45 17 68 68
a s s u ra n ce s
Registered office, 27 rue Maurice Flandin - BP 3261 69403 Lyon Cedex 03 Fax 04 78 53 65 18 - Internet www.april.fr
APRIL ASSURANCES IS A DIVISION OF APRIL GROUP
Insurance management and broking SA with capital of 500,000 - Registered on the ALCA list - 428 702 419 RCS Lyon. Financial and professional civil liability cover in accordance with sections L530.1 and L530.2 of the Insurance Code.
Réf. 10001 - All marks, logos, graphic layout and promotional text contained in this document are registered and the property of APRIL Assurances SA.
· Immediate processing of documentation for management within amaximum 24 hours.
These elements, and text of any kind, may not be reproduced in whole or in part. Failure to comply with this rule will lead to legal action. *cumulative total of "satisfied" and "fairly satisfied" replies to an IPSOS phone survey carried out in May 2004 with a sample of 800 people insured. **ccumulative total of "would certainly recommend" and "would probably recommend" replies to an IPSOS phone survey carried out in May 2004 with a sample of 240 correspondents and October-November 2004 with a sample of 240 correspondents.
Reserved for APRIL Assurances
P RE 3101
000E0ECL
Subscription application
Stamp and signature of insurance consultant
Insurance consultant no. 4 5 4 5 5 Fax sent on subscriber no. YES NO Are you already insured with APRIL Assurances
C: COURTAGE 17 Villa du Petit Parc 94000 CRETEIL Tél. : 01 45 17 68 68
PLEASE COMPLETE THIS SUBSCRIPTION APPLICATION IN BLOCK CAPITALS Subscriber (if different from Insured 1)
Company name/Name : ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ A ddress : .................................................................................................................................................................................................................................................................................. Post code : Town : ......................................................................................................................................................................
INSURED 1
Mr
Mrs
Ms
Name : .................................................................................................................................................................................................................... First name : .......................................................................................................................................................................... Date of birth Are you an executive or entitled to the benefits of an AGIRC retirement scheme ? Yes No Profession : ........................................................................................................ Present address : ................................................................................................................................................................................................................................................ Phone (home) M obile Planned date of removal : Future address : .............................................................................................................................................................................................................................................. Post code Email : Post code Town :
......................................................................................................................................................................
............................................................................................................................................................................................................................
Town :
..........................................................................................................................................................................
INSURED 2
Mr
Mrs
Ms
(corresp ondence for this subscription will only be sent to insured 1)
Name : ...................................................................................................................................................................................................................... First name : ............................................................................................................................................................................ Date of birth Are you an executive or entitled to the benefits of an AGIRC retirement scheme ? Yes No Profession : ........................................................................................................ Residence in French Overseas Territories: Yes No
Characteristics of loan 1
Insurance start date (Date of signing loan offer) : Date of 1st repayment : If unknown, set it a fortnight before the presumed date of signature of the loan offer
If loan repayment other than monthly, please specify : .................................................................................................................................................................................................................................................................................................................................
Loan amount
......................................................................................................................................................................................
Total duration of loan
(including deferred or advance payment period)
Rate type Fixed Variable
Interest rate
............................................
Euros Leasing Successive release No Yes
months In Interest-only Europlan
%
Typ e of loan :
Classic Zero-interest loan
Flexible Bridging loan Staged loan Other : ................................................................................................................................................................................................
Date de déblocage des fonds : Deferred amortization or pre-payment period : Lending organisation Numb er of months :
Name : .................................................................................................................................. A ddress : ............................................................................................................................................................................................................................................................ Post code : Town : .............................................................................................................................................................................................. Phone : Fax : If the delegation of benefit is to be sent to another address (branch or registered office), give details : .......................................................................................................................................................................................... A dress : .................................................................................................................................................................................................................................................................................. Post code : Town : ................................................................................................................................................ Phone : Fax : Email : .................................................................................................................................................................................................................................. If the beneficiary is not the lender, please send us the bank's written agreement and specify the beneficiary clause (example for downloading on Intrapril):
....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Direct debit authorisation
I authorise the establishment holding my account to debit the account, if its situation allows, with all debit amounts specified by the creditor shown opp osite. In the case of a dispute on the debit amount I will be able to susp end execution by simple request to the establishment holding my account. I will settle the dispute directly with the creditor.
The creditor : APRIL Assurances N° national issuer no. : 142 662 27 rue Maurice Flandin - BP 3261 - 69403 LYON CEDEX 03
Codes Establishment Branch no.
Account to be debited
Account no. Check code
Mandator y N a me :
Debtor
Name : A dress :
Establishment holding account to be debited
.................................................................................................................................................................................................................................................................. ..................................................................................................................................................................................................................................................................
First name : ................................................................................................................................................................................................................ A dress : .................................................................................................................................................................................................................................. Post code Signature : Town : ................................................................................ Date
..................................................................................................................................................................................................................................................................................................
Post code
Town :
............................................................................................................................................................
02
subscription application
creditor, I send this form to the ice account t off taching a bank or pos RIP - mandatory) at B or identification slip (RI the back) (stapled to
Characteristics of loan 2
Insurance start date (Date of signing loan offer) : Date of 1st repayment : If unknown, set it a fortnight before the presumed date of signature of the loan offer
If loan repayment other than monthly, please specify : .................................................................................................................................................................................................................................................................................................................................
Loan amount
......................................................................................................................................................................................
Total duration of loan
(including deferred or advance payment period)
Rate type Fixed Variable
Interest rate
............................................
Euros Leasing Successive release No Yes
months In Interest-only Europlan
%
Typ e of loan :
Classic Zero-interest loan
Flexible Bridging loan Staged loan Other : ................................................................................................................................................................................................
Date de déblocage des fonds : Deferred amortization or pre-payment period : Lending organisation Numb er of months :
Name : .................................................................................................................................. A ddress : ............................................................................................................................................................................................................................................................ Post code : Fax : Town : .............................................................................................................................................................................................. Phone : If the delegation of benefit is to be sent to another address (branch or registered office), give details : .......................................................................................................................................................................................... A ddress : ............................................................................................................................................................................................................................................................................ Post code : Town : ................................................................................................................................................ Phone : Fax : Email : .................................................................................................................................................................................................................................. If the beneficiary is not the lender, please send us the bank's written agreement and specify the beneficiary clause (example for downloading on Intrapril):
....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
INSURED 1
Death/TILA coverage (DC) rate Total amount of premium inc. VAT (1)
INSURED 2
Death/TILA coverage (DC) rate Total amount of premium inc. VAT (1)
Loan 1
...................................................................................
%
...................................................................................
e
Loan 1
...................................................................................
%
...................................................................................
e
Loan 2
...................................................................................
%
...................................................................................
e
Loan 2
...................................................................................
%
...................................................................................
e
(NF)
(NF)
Non-smoking declaration Insured 1 I declare on my honour that I do not smoke or stopped smoking at least 10 years prior to the date of signature of this application for insurance, and that I have not stopped smoking on doctor's orders. I undertake to inform the insurer if I start smoking again, even occasionally, during the contract term. The insurer reserves the right to carry out any check that it considers necessar y during the contract term. (check then date and sign at the bottom of this page)
(1) Indiqué sur votre étude personnalisé.
Non-smoking declaration Insured 2 I declare on my honour that I do not smoke or stopped smoking at least 10 years prior to the date of signature of this application for insurance, and that I have not stopped smoking on doctor's orders. I undertake to inform the insurer if I start smoking again, even occasionally, during the contract term. The insurer reserves the right to carry out any check that it considers necessar y during the contract term. (check then date and sign at the bottom of this page)
If I have other loans: I complete the "Additional loans" form.
Payment by direct debit
Frequency : monthly quarterly six-monthly annual Payment charge : e2.29 per payment Indicate the day of the month for debiting your premium, between 1st and 10th. Subscription fee : e20 (This amount is not due if the subscriber is already insured with APRIL Assurances) I attach a cheque in advance payment - amount e ...................................................................... (minimum e45) made out to APRIL Assurances.
I apply for subscription to the APRIL Assurances "Association des Assurés" and its subscribed agreement with Axeria for loan insurance cover. "I declare that I have been informed of the statutes and internal regulations of the APRIL Assurances "Association des Assurés". I declare that I have been informed of the general terms serving as information notice, reference PRES2 05-08/05, for my cover as attached to this subscription application, and in particular of my right to withdrawal, that I accept their provisions and have kept a copy of them, together with the terms applicable to APRIL Assurances management operations. Within the framework of modification of my contract by means of an additional clause, I note that the general terms applicable are those of which I was informed on signature of the initial subscription application and referenced above. I confirm that I have been informed that the information collected is necessary for the assessment and processing of my subscription application, and that the administrative information is subject to computer processing by April Assurances and the Insurer, or their authorised agent, for requirements associated with execution of my subscription to the contract. In accordance with the law of 6 January 1978 (modified), I have the right to access and, if necessary, rectify any information concerning me held in these files by writing to APRIL Assurances - 27 rue Maurice Flandin, 69003 Lyon. APRIL Assurances may use certain administrative information and communicate this information to its partners, a list of which will be sent to me on request, in order to enable them to offer me new products or services. In accordance with the law of 6 January 1978 (modified), I can oppose such communication by simply writing to APRIL Assurances (at the above address), and the postage cost will be refunded to me. I declare that I have been informed that my phone communications with April Assurances offices may be recorded for internal management purposes. I may obtain access to the records concerning me by sending a letter to the following address: APRIL Assurances, 27 rue Maurice Flandin, BP 3261, 69403 LYON CEDEX 03, it being understood that each record is kept for a maximum period of two months. I, the undersigned, declare that I have answered the questions asked exactly and sincerely, and that I have not declared anything or omitted to declare anything that could mislead the April Assurances "Association des Assurés" Insurer.
Signed in Signature of Subscriber, preceded by the wording "read and approved" Date Signature of Insured 1 preceded by the wording "read and approved" Signature of Insured 2 preceded by the wording "read and approved"
03
subscription application
Copy for INSURED
subscrib er no.
Health questionnaire
(
1 2 3 4 5 6 7 8 9
"You must take care to answer all questions on this health questionnaire yourself, as exactly as possible, since your statements are legally binding. This health questionnaire is essential for assessment of the risk that the insurer intends to cover. Failure to reply to one of the questions may give rise to rejection of the contract subscription application. The medical information you communicate is covered by professional confidence. In order to keep it confidential, if you have answered "YES" to one of the questions, you must transmit this health questionnaire, duly completed and signed, in, a sealed envelope, to the April Assurances Medical Examiner. Medical questionnaire valid for 3 months from date of signature.
)
Insured 1
Name : ........................................................................................ First name : ................................................................................ Weight : .................................. in kg Height : .......................................................................... in cm
yes yes no no Since when ? Why ? ...................................................................................... After-effects ? ............................................................................................................................................................................ Reason ? ........................................................................................................................................................................................ Which ? .......................................................................................................................................................................................... .............................................................................................................................................................................................................. Treatment ?................................................................................................................................................................................ .............................................................................................................................................................................................................. Which ?..................................................................................................... Date Treatment ?................................................................................. How often ? ............................................................ Which ?...................................................................................... After-effects ?............................................................ for visual problems, state visual acuity after correction : Right eye ............................................................................ Left eye ............................................................................ Nature ? ........................................................................................................ Date Treatment ?................................................................................. How often ? ............................................................ Nature ? ........................................................................................................ Date Area of injuries ? .................................................................................................................................................................... Treatment ? .............................................................................................................................................................................. Which ?..................................................................................................... Date If yes, which ? .......................................................................................................................................................................... Do you want to be covered for this risk ? yes no
Signature of Insured 1
Have you been hospitalised in the past 10 years for over 10 days are you due to undergo a surgical operation ? Are you 100% covered for a long term illness ? Are you receiving treatment for hypertension ? diabetes ? a circulation disorder ? high cholesterol ? hormone disease ? neuropsychic disorder ? gastric disease ? genital disease ? gout ?
yes
no
Do you have a cardiac and/or vascular disease? a respiratory disease ? Are you affected by a congenital malformation or infirmity ? visual or hearing problems ? Do you have kidney or liver disease ? Do you have rheumatic or bone disorders, disc or vertebra disorders, osteoarthritis, hip problems? Have you had other illnesses ? Do you practise a sport ?
NFI CO
yes yes yes yes yes yes
TIAL DEN
no no no no no no
I certify that the information given above is exact and declare that I agree to communication of this information to the April Assurances Medical Examiner. I confirm that I have been informed that any nondisclosure or false declaration will render the cover subscribed null and void, or terminate or reduce cover in application of articles L113-8 and L113-9 of the Insurance Code.
Date
Insured 2
1 2 3 4 5 6 7 8 9
Name : ........................................................................................ First name : ................................................................................ Weight : .................................. in kg Height : .......................................................................... in cm
yes yes no no Since when ? Why ? ...................................................................................... After-effects ? ............................................................................................................................................................................ Reason ? ........................................................................................................................................................................................ Which ? .......................................................................................................................................................................................... .............................................................................................................................................................................................................. Treatment ?................................................................................................................................................................................ .............................................................................................................................................................................................................. Which ?..................................................................................................... Date Treatment ?................................................................................. How often ? ............................................................ Which ?...................................................................................... After-effects ?............................................................ for visual problems, state visual acuity after correction : Right eye ............................................................................ Left eye ............................................................................ Nature ? ........................................................................................................ Date Treatment ?................................................................................. How often ? ............................................................ Nature ? ........................................................................................................ Date Area of injuries ? .................................................................................................................................................................... Treatment ? .............................................................................................................................................................................. Which ?..................................................................................................... Date If yes, which ? .......................................................................................................................................................................... Do you want to be covered for this risk ? yes no
Signature of Insured 2
Have you been hospitalised in the past 10 years for over 10 days are you due to undergo a surgical operation ? Are you 100% covered for a long term illness ? Are you receiving treatment for hypertension ? diabetes ? a circulation disorder ? high cholesterol ? hormone disease ? neuropsychic disorder ? gastric disease ? genital disease ? gout ?
yes
no
Do you have a cardiac and/or vascular disease? a respiratory disease ? Are you affected by a congenital malformation or infirmity ? visual or hearing problems ? Do you have kidney or liver disease ? Do you have rheumatic or bone disorders, disc or vertebra disorders, osteoarthritis, hip problems? Have you had other illnesses ? Do you practise a sport ?
NFI CO
yes yes yes yes yes yes
TIAL DEN
no no no no no no
I certify that the information given above is exact and declare that I agree to communication of this information to the April Assurances Medical Examiner. I confirm that I have been informed that any nondisclosure or false declaration will render the cover subscribed null and void, or terminate or reduce cover in application of articles L113-8 and L113-9 of the Insurance Code.
04 subscription application Date
Medical formalities
Capital insured in From e7,500 to e75,000 From e75,001 to e150,000 From e150,001 to e310,000 Age on subscription up to 80 Health questionnaire (9 questions) Health questionnaire + Medical report Standard medical documentation
Standard medical documentation : prop osal with medical questionnaire + medical report + Blood profile 1 + cytobacteriological examination of urine and chemistry of urine + electrocardiogram with cardiologist's report. Blood profile 1 : blo o d count, blood sedimentation rate, measurement of glycaemia, creatinine, urea, uric acid. Tests for antiHIV1 and 2 antibodies by enzymology (2 reagents), hepatic enzyme profile (with Gamma GT, transaminases SGOT-SGPT, alkaline phosphatases), lipids profile (with total cholesterol, HDL, LDL, total cholesterol/HDL ratio, triglycerides), measurement of HBs antigens, anti-HBc antibodies, anti-HCV antibodies.
05
subscription application