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SafetyTool Order - Insured Person (Mandatory)


Surname
First name
Title / Mrs./Mr.	Ms. Mr. None
Date of birth Nation / Language
Email

Main Residence (Mandatory)

Due to country-specific legislation we can only offer a SafetyTool policy if your main residence is in one of the selectable EU-countries. If you are living in Switzerland, the SafetyTool policy is valid only outside Switzerland.
If the country of your main residence is not in the list, regrettably we can't offer the SafetyTool to you.

Country / Zip Code

City

Street

c/o

Phone

Cooperation Partner (Optional)

If SafetyTool was recommend by the watersport center, enter it's partner code (VDWS member code) here. Leave empty if unknown.

Partner Code

Start and duration of insurance (Optional)

Insurance period will start today or in 14 to 90 days, at your choice.Please be aware, however, that according to VVG §8.3(2) you will loose your 14-day cancellation period, should the insurance start earlier than within 14 days.In any case, insurance protection is subject to payment of insurance fee.

Start of insurance			As soon as possible I understand that this will void my cancellation period!
Duration

Confirmation (Mandatory)I formally confirm that my name, date of birth, nationality and details regarding principal place of residence have been given correctly. Moreover I acknowledge that the validity of the SafetyTool policy is dependent on the so-called obligations to disclose in the insurance terms and conditions, and that if there is a breach of these, the specified legal consequences will come into effect.

I have read the insurance terms and conditions and the product information leaflet and declare my agreement.

I have read the data protection terms and declare my agreement.

I hereby request entry into, respectively admission as an insured person into, the group insurance contract VDWS SafetyTool between VDWS Service GmbH and the AXA Versicherung AG, placed through SüdwestRing Versicherungsmakler GmbH. I have read the general information, the broker appointment and the consultation documentation from the insurance broker and declare my agreement.

Enter letters shown (case doesn't matter)

VDWS

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