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C : COURTAGE
Votre spécialiste en assurance de prêt
H
A
B
I
T
A
T
Loan Insurance
(
Cu s t o m i s e d rates
Standard LnI 2
Fo r the under-60's
)
Borrowers' insurance
Subscription application - 2005/2006 F o r loans of E15,000 to E310,000
S p e c i a l rates for couples and non-smokers " B o n u s " ser v i c e s : assistance with works and removal
a s s u ra n ce s
Reserved for APRIL Assurances
PRE 7101
000EBG0T 000C6RNS
Subscription application
Borrowers' insurance
Stamp and signature of insurance consultant
Insurance consultant no. 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)
Company name/Name: A dress:
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................................................
Post Code:
Town:
..........................................................................................................................................................................
INSURED 1
Mr
Mrs
Ms
Name: .......................................................................................................................................................................................................................... First name: ................................................................................................................................................................................ Date of birth Status: Executive Executive category Profession Non-executive Trader Artisan Farmer Other: .................................................................................................................................................................................................. Exact profession: ..................................................................................................................................................................................................................................................................... A ctivity sector: ............................................................................................................................................................................................................................. Work abroad (outside EU) No Yes Countr y: ........................................................................................................................................................................................................................................................................................................................................................................................................ No. of business km/year (excluding journey between home and work): 15,000 km/year + 15,000 km/year Do you regularly handle loads in your work? Yes No Do you work at a height of over 15 metres? Yes No Work contract: Permanent employment Fixed term contract Temporary worker/Seasonal worker <1/2 time Present address: Post Code: Phone Mobile (or home) Future address: Post Code: Town:
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Town: ...................................................................................................... Planned date of removal:
..................................................................................................................................................................
E-mail :
......................................................................................................................................................................................................................................................................
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
INSURED 2
Mr
Mrs
Ms
(corresp ondence for this subscription will only be sent to insured 1)
Name: .......................................................................................................................................................................................................................... First name: ................................................................................................................................................................................ Date of birth Status: Executive Executive category Profession Non-executive Trader Artisan Farmer Other: .................................................................................................................................................................................................. Exact profession: ..................................................................................................................................................................................................................................................................... A ctivity sector: ............................................................................................................................................................................................................................. Work abroad (outside EU) No Yes Countr y: ........................................................................................................................................................................................................................................................................................................................................................................................................ No. of business km/year (excluding journey between home and work): 15,000 km/year + 15,000 km/year Do you regularly handle loads in your work? Yes No Do you work at a height of over 15 metres? Yes No Work contract: Permanent employment Fixed term contract Temporary worker/Seasonal worker <1/2 time
*All activities involving manipulation and/or movement of objects/goods considered heavy or dangerous exercised regularly during your work.
Payment by direct debit
Frequency: monthly quarterly six-monthly annual Payment charge: e2,29 per payment Subscription fee: e20 (This amount is not due if the subscriber is already insured with APRIL Assurances) I enclose a cheque in advance payment for the amount of e45 made out to APRIL Assurances.
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 suspend execution by simple request to the establishment holding my account. I will settle the dispute directly with the creditor.
The creditor: APRIL Assurances national issuer no.: 142 662 27 rue Maurice Flandin - BP 3261 - 69403 LYON CEDEX 03
Codes Establishment Branch no.
Account to be debited
A ccount no Check code
Mandator y fields
Debtor
Establishment holding account to be debited Name: ...................................................................................................................................................................................................................................................................... A dress: ....................................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................................................................
Name: .................................................................................................................................................................................................................................. First name:.................................................................................................................................................................................................................... A dress: .................................................................................................................................................................................................................................... Post code Signature : Town:...................................................................................... Date
Post Code
Town:
............................................................................................................................................................
creditor, I send this form to the ice account bank or post off y) attaching a B or RIP - mandator identification slip (RI the back) (stapled to
02
Subscription application
Characteristics of loan 1
Insurance start date (Date of signing loan offer):
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
.........................................................................................................................................................................................
(including deferred or advance payment period)
Total duration of loan months
Rate type Fixed Variable
Interest rate
............................................
Euros
%
Typ e of loan: Fund release date Lending organisation
Classic Leasing Interest-only Zero-interest loan (loan with capitalized interest?)
Flexible Bridging loan Staged loan Successive release Europlan Other: ............................................................................ No Yes Numb er of months:
Deferred amortization or pre-payment period:
Name: .................................................................................................................................... A dress: ...................................................................................................................................................................................................................................................................... Post Code: Fax: Email : ...................................................................................................................................... Town: .................................................................................................................................... Phone: 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 (e.g. available on Intrapril):
..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Characteristics of loan 2
Loan amount
.........................................................................................................................................................................................
(including deferred or advance payment period)
Total duration of loan months
Rate type Fixed Variable
Interest rate
............................................
Euros
%
Typ e of loan: Fund release date
Classic Leasing Interest-only Zero-interest loan (loan with capitalized interest?)
Flexible Bridging loan Staged loan Successive release Europlan Other: ............................................................................ No Yes Numb er of months:
Deferred amortization or pre-payment period:
If I have other loans or the nature of loan 2 is different (lending organisation, beneficiary clause, coverage rate, etc.): I complete the "Additional loans" form.
In suré 1 A ssured 1
Fra c c is s ITT/IPT(AT) Taux de couverture Frannhhie e ITT/IPT Taux TTIW/PT1) D Death/TIL A ITT/IPT( de couverture coverage rate (2) coverage rate (1) (AT) DC/PTIA (DC) 03 30 j 2 03 30 d 002 60 dj 60
...........................................
Unemtion ment option (2) (C9) Op ploy chômage (2)
(C9)
%
...........................................
%
01 01
90 j 90 d
04 04
Yes Rate: ..........................................% Oui Taux : ..........................................% Dte e of hiring bychez votre employeur at d'embauche your current employer Da 180 d actuel 180 j
Option Option Total amountaof globalpremium Mont nt the Sp écial Sp ecial Option per loan de la cotisation parpersonalised shown on the prêt Professions Medical indiqué sur l'étudeypersonnalisée (3) stud (3) Médicales Professions (IP)
(IP)
Oesi Yu
..................................................................................................... ..............
e INCVAT e .VAT
In suré 1 A ssured 2
Fra c c is s ITT/IPT(AT) Taux de couverture Frannhhie e ITT/IPT Taux TTIW/PT1) D Death/TIL A ITT/IPT( de couverture coverage rate (2) coverage rate (1) (AT) DC/PTIA (DC) 03 30 j 2 03 30 d 002 60 dj 60
...........................................
Unemtion ment option (2) (C9) Op ploy chômage (2)
(C9)
%
...........................................
%
01 01
90 j 90 d
04 04
Yes Rate: ..........................................% Oui Taux : ..........................................% DDte e of hiring bychez votre employeur a at d'embauche your current employer 180 d actuel 180 j
Option Option Total amountaof globalpremium Mont nt the Sp écial Sp ecial Option per loan de la cotisation parpersonalised shown on the prêt Professions Medical indiqué sur l'étudeypersonnalisée (3) stud (3) Médicales Professions (IP)
(IP)
Oesi Yu
..................................................................................................... ..............
e INCVAT e .VAT
(1) TTIW/PTD option impossible: - If the amortization deferment is between 6 and 24 months with irregular repayments, - if total deferred and partial deferred of 24 months or over, - for residents in the French overseas territories and Corsica. (2) Possible only if TTIW/PTD subscribed; coverage rate equal to that of TTIW/PTD within the limit of a maximum covered capital amount of 150,000. The unemployment option may only be subscribed by an Insured person occupying full time employment on a permanent work contract for over a year with the same employer, not awaiting layoff or under notice of dismissal, in pre-retirement, on a trial period or on short-time working. (3) Subject to acceptance by 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 articles 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 PRE2 05-10/05 (for loan insurance cover) and PRE2C 04-10/04 (for unemployment cover), 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 (if different from Insured 1) 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
subscrib er no:
Health questionnaire
(
Borrowers' insurance
You must answer all these questions 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 will give rise to additional requests. The medical information you communicate is covered by professional confidentialit y. By giving us as much information as possible, you will help us to give you an answer as soon as possible. In order to keep this questionnaire confidential, please send it in a sealed envelope to the APRIL Assurances Medical Examiner.
Insured 1
Weight:
Name:
....................................................................................................
First name:
)
............................................................................................................................
I declare that I have been informed that people suffering from one of the following illnesses or disorders: hepatitis, type 1 diabetes, multiple sclerosis, cancer within the past 5 years, organ transplant, haemophilia, genetic disease, or HBV, HCV or HIV positive, are not covered by LnI Standard 2 and should take out "Solution" LOAN INSURANCE.
1 2 3
..............................................................................................
Height:
yes
.............................................................................................. no Type of illness or disorder: ..................................................................................................................................................................................................
Did you smoke during the past 2 years? Are you suffering from, or have you suffered from, a disease or a chronic or recurring illness, an infirmity or after-effects (accident or illness)? a- Are you currently on sick leave following an accident or illness (except legal maternity leave)?
yes yes yes yes
no no no no
............................................................................................................................................................................................................................................................................................................
When: ................................................................................................................................................ Duration: .................................................................................. Reason: .............................................................................................................................................................................................................................................................................. Since when: .......................................................................................................................................................................................................................................................... Reason: ............................................................................................................................................................................................................................................................................ Start date End date Reason:
............................................................................................................................................................................................................................................................................
4
b- Have you been on sick leave for over 30 days during the past 5 years? c- Do you have special working hours and/or conditions for medical reasons?
5 6 7
Have you been operated on or hospitalized during the past 10 years (except for maternity, appendicitis, tonsils, adenoids, varicose veins, wisdom teeth, bladder, hiatus or inguinal hernia, haemorrhoids, deviation of the nasal septum, caesarean, voluntary termination of pregnancy)? Do you have or have you had any rheumatic illnesses or disc/vertebral disorders? Have you had any injuries to your joints, muscles or ligaments during the past 5 years? Do you take or have you taken medical treatment for: - a cancerous disease, - a neurological disorder (e.g. epilepsy, etc.), - a psychiatric disorder (e.g. nervous breakdown, etc.), - a metabolic disorder (e.g. cholesterol, triglycerides, diabetes, etc.), - a pulmonary disease (e.g. asthma, etc.), - a rheumatic disease (e.g. lumbago, sciatica, etc.), - an endocrine disorder (e.g. thyroid, etc.), - or for any other illness with treatment for over a month (e.g. renal, urinary, genital or hepatic disorder, infectious illnesses, etc.). - or a cardiac or vascular disease (e.g. hypertension, etc.),
yes
no
Reason: .......................................................................................................... When: ................................................................................................................................ Duration of hospitalisation: .............................................................................................................................................................................................. Which: Which:
........................................................................................................
yes yes yes yes yes yes yes yes yes yes
no no no no no no no no no no no no no no no
........................................................................................................................................
8
C
IDEN ONF
* yes yes yes yes yes
........................................................................................................................................
Reason: ............................................................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................
TIEL
........................................................................................................
Area of injuries: Since when Area of injuries: Date
............................................................................................
............................................................................................
Which: ..............................................................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................
9
a- Are you or have you been under medical supervision? (excluding occupational medicine and systematic follow-up during pregnancy) b- During the past 12 months, have you had blood or urine tests, X-rays, MRI, scanner or a colonoscopy? c- During the next 12 months, are you planning to have blood or urine tests, X-rays, MRI, scanner or a colonoscopy? Do you have an eye disease or severe myopia (less than 8/10 after correction), blindness, even in one eye? Are you pregnant? a- Do you practise a sport within the framework of amateur competitions and/or as a member of a federation and/or a club?
Since when: .......................................................................................................................................................................................................................................................... Duration of treatment: ............................................................................................................................................................................................................ *If yes, blood pressure: ................................................................................................................................................................................................................ Why: ...................................................................................................................................................................................................................................................................................... Since when: .......................................................................................................................................................................................................................................................... Reason: ............................................................................................................................................................................................................................................................................ Result:: .............................................................................................................................................................................................................................................................................. Reason: ............................................................................................................................................................................................................................................................................ Reason: ............................................................................................................................................................................................................................................................................ Treatment: ............................................................................................................................................................................................................................................................ In the case of sight problems: visual acuity after correction: Right eye: .................................................................................................................. Left eye: .......................................................................................................................... Since when:
..........................................................................................................................................................................................................................................................
10 11 12 13
yes yes
no no
b- Do you practise one of the following sports: bobsleigh, snowmobile, ski-bob, skeleton, underwater scuba diving or fishing, sailing, potholing, climbing, mountaineering, bungee-jumping, canyoning, catamaran. Do you practise an aerial activity?
yes
no
If yes, which: ...................................................................................................................................................................................................................................................... If this sport is shown in the list of "specific" sports on the back of this document, do you want to be covered for this sport: yes (1) non If yes, which: ...................................................................................................................................................................................................................................................... How often: .............................................................................................................................................................................................................................................................. Do you want to be covered for this sport: yes (1) non Which: .............................................................................................................................................................................................................................................................................. Do you want to be covered for this risk: yes (2) non
yes
no
(1) If you practise a sport presenting a particular risk, an additional study will be carried out. (2) Subject to acceptance by APRIL Assurances, which will be shown on your certificate of cover.
Signed in Signature of Insured 1
Date
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 non-disclosure 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
subscrib er no:
Health questionnaire
(
Borrowers' insurance
You must answer all these questions 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 will give rise to additional requests. The medical information you communicate is covered by professional confidentialit y. By giving us as much information as possible, you will help us to give you an answer as soon as possible. In order to keep this questionnaire confidential, please send it in a sealed envelope to the APRIL Assurances Medical Examiner.
Insured 2
Weight:
Name:
....................................................................................................
First name:
)
............................................................................................................................
I declare that I have been informed that people suffering from one of the following illnesses or disorders: hepatitis, type 1 diabetes, multiple sclerosis, cancer within the past 5 years, organ transplant, haemophilia, genetic disease, or HBV, HCV or HIV positive, are not covered by LnI Standard 2 and should take out "Solution" LOAN INSURANCE.
1 2 3
..............................................................................................
Height:
yes
.............................................................................................. no Type of illness or disorder: ..................................................................................................................................................................................................
Did you smoke during the past 2 years? Are you suffering from, or have you suffered from, a disease or a chronic or recurring illness, an infirmity or after-effects (accident or illness)? a- Are you currently on sick leave following an accident or illness (except legal maternity leave)?
yes yes yes yes
no no no no
............................................................................................................................................................................................................................................................................................................
When: ................................................................................................................................................ Duration: .................................................................................. Reason: .............................................................................................................................................................................................................................................................................. Since when: .......................................................................................................................................................................................................................................................... Reason: ............................................................................................................................................................................................................................................................................ Start date End date Reason:
............................................................................................................................................................................................................................................................................
4
b- Have you been on sick leave for over 30 days during the past 5 years? c- Do you have special working hours and/or conditions for medical reasons?
5 6 7
Have you been operated on or hospitalized during the past 10 years (except for maternity, appendicitis, tonsils, adenoids, varicose veins, wisdom teeth, bladder, hiatus or inguinal hernia, haemorrhoids, deviation of the nasal septum, caesarean, voluntary termination of pregnancy)? Do you have or have you had any rheumatic illnesses or disc/vertebral disorders? Have you had any injuries to your joints, muscles or ligaments during the past 5 years? Do you take or have you taken medical treatment for: - a cancerous disease, - a neurological disorder (e.g. epilepsy, etc.), - a psychiatric disorder (e.g. nervous breakdown, etc.), - a metabolic disorder (e.g. cholesterol, triglycerides, diabetes, etc.), - a pulmonary disease (e.g. asthma, etc.), - a rheumatic disease (e.g. lumbago, sciatica, etc.), - an endocrine disorder (e.g. thyroid, etc.), - or for any other illness with treatment for over a month (e.g. renal, urinary, genital or hepatic disorder, infectious illnesses, etc.). - or a cardiac or vascular disease (e.g. hypertension, etc.),
yes
no
Reason: .......................................................................................................... When: ................................................................................................................................ Duration of hospitalisation: .............................................................................................................................................................................................. Which: Which:
........................................................................................................
yes yes yes yes yes yes yes yes yes yes
no no no no no no no no no no no no no no no
........................................................................................................................................
8
C
IDEN ONF
* yes yes yes yes yes
........................................................................................................................................
Reason: ............................................................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................
TIEL
........................................................................................................
Area of injuries: Since when Area of injuries: Date
............................................................................................
............................................................................................
Which: ..............................................................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................
9
a- Are you or have you been under medical supervision? (excluding occupational medicine and systematic follow-up during pregnancy) b- During the past 12 months, have you had blood or urine tests, X-rays, MRI, scanner or a colonoscopy? c- During the next 12 months, are you planning to have blood or urine tests, X-rays, MRI, scanner or a colonoscopy? Do you have an eye disease or severe myopia (less than 8/10 after correction), blindness, even in one eye? Are you pregnant? a- Do you practise a sport within the framework of amateur competitions and/or as a member of a federation and/or a club?
Since when: .......................................................................................................................................................................................................................................................... Duration of treatment: ............................................................................................................................................................................................................ *If yes, blood pressure: ................................................................................................................................................................................................................ Why: ...................................................................................................................................................................................................................................................................................... Since when: .......................................................................................................................................................................................................................................................... Reason: ............................................................................................................................................................................................................................................................................ Result:: .............................................................................................................................................................................................................................................................................. Reason: ............................................................................................................................................................................................................................................................................ Reason: ............................................................................................................................................................................................................................................................................ Treatment: ............................................................................................................................................................................................................................................................ In the case of sight problems: visual acuity after correction: Right eye: .................................................................................................................. Left eye: .......................................................................................................................... Since when:
..........................................................................................................................................................................................................................................................
10 11 12 13
yes yes
no no
b- Do you practise one of the following sports: bobsleigh, snowmobile, ski-bob, skeleton, underwater scuba diving or fishing, sailing, potholing, climbing, mountaineering, bungee-jumping, canyoning, catamaran. Do you practise an aerial activity?
yes
no
If yes, which: ...................................................................................................................................................................................................................................................... If this sport is shown in the list of "specific" sports on the back of this document, do you want to be covered for this sport: yes (1) non If yes, which: ...................................................................................................................................................................................................................................................... How often: .............................................................................................................................................................................................................................................................. Do you want to be covered for this sport: yes (1) non Which: .............................................................................................................................................................................................................................................................................. Do you want to be covered for this risk: yes (2) non
yes
no
(1) If you practise a sport presenting a particular risk, an additional study will be carried out. (2) Subject to acceptance by APRIL Assurances, which will be shown on your certificate of cover.
Signed in Signature of Insured 2
Date
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 non-disclosure 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.
05 Subscription application
Excluded professions
Security firm transporting money, work in mines or underground or in tunnels, high mountain guide/ski monitor, sea fishing, armed sur veillance/maintenance of order, professional fire brigade, professional sportsperson (including sports using a motor vehicle), fireworks or bomb disposal expert/use of explosives, cinema or television artist/intermittent show business worker/professional circus performer. For these professions, we recommend you use "Solution" loan insurance. Please ask your insurance consultant for information.
Specific sports* · Equestrian sports: horse shows, hurdling, cross country, polo, · Motor sports: hill-climbing, speed trials, Formula 1-2-3, go-karting, · Motorbike sports: circuit racing, hill-climbing, endurance, enduro, · Winter sports: competition sledging, competition skating,
extreme skiing, bobsleigh, snow scooter, ski-bob. rallies, long-distance rallies, stock car racing. moto cross, quad in competition, long-distance rallies, speedway, trial. ro deo.
· Water sports: rafting, jet ski, outboard racing, offshore racing,
navigation over 20 miles from coast., scuba diving or fishing, canyoning, catamaran. · Other sports: Boxing and martial arts in competition, American fo otball (if TTIW/PTD waiting period is 30 days), amateur rugby (if TTIW/PTD waiting period is 30 days), competition mountain biking, triathlon, skeleton, sailing, potholing, climbing, mountaineering, bungee-jumping.
*For these specific sports, an assessment will be carried out if you want to be covered to practise one of them.
Medical formalities
The medical formalities required depend on the capital insured per person and not on total capital borrowed.
Capital insured in E From e15 000 to e110 000 From e110 001 to e185 000 From e185 001 to e310 000 Under 55 years old Health questionnaire Health questionnaire Health questionnaire + Blood profile 1 55-59 years old Health questionnaire Health questionnaire + Medical report Standard medical documentation
If you already have a loan insurance or providence contract with APRIL Assurances, reduced medical formalities may be p ossible. Medical report: document sent by APRIL Assurances for completion by a doctor Blood profile 1: blood count, blood sedimentation rate, measurement of glycaemia, creatinine, urea, uric acid. Tests for anti-HIV1 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. Standard medical documentation: proposal with medical questionnaire + medical report + Blood profile 1 + cytobacteriological examination of urine and chemistry of urine + electrocardiogram with cardiologist's report
I enclose
· My subscription application: completed, dated and signed by the 2 insured (p. 2, 3, 4 and 5) · My direct debit authorisation: completed and signed · My bank or post office account identification slip · My cheque for the advance payment: made out to APRIL Assurances · Supporting medical documentation if the questionnaire contains positive answers.
06
Subscription application
And after subscription?
Your subscription application is processed as soon as it is received by APRIL Assurances: you receive your insurance documentation from your broker. Your delegation of benefit* is sent directly to your bank, so your loan can be released as soon as possible.
(
our subscription application is sent
Y
)(
rocessing by APRIL Assurances
P
)( ) )
)
( (
T
he delegation of benefit* is faxed and/or posted to the bank
)(
T
he bank can release the funds
Your insurance documentation is sent to your broker
)(
ou have all your documents
Y
(
07
* Delegation of benefit: · The bank becomes the beneficiary of your insurance throughout the term of your loan. · The capital on death or your loan repayments in the case of work stoppage (if this option is subscribed), are repaid to it. · Any modification to the contract must be made with the agreement of your bank.
)
Subscription application
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
· Immediate processing of documentation for management within a maximum 24 hours. · 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 was listed as one of "25 great 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 "Second Marché" of the Paris bourse (SRF 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. 10000 - All marks, logos, graphic layout and promotional text contained in this document are registered and the property of APRIL Assurances SA. 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. **cumulative 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.