Request a quote from Allianz Partners

Please complete the following form to receive an insurance quote from our partner “Allianz Partners”.

Insurance no. (if already insured with Groupe Mutuel)

Title *

Name *

First name *

Date of birth *

Address

Telephone number *

Email address *

Nationality *

Current insurer *

Do have supplemental insurance pursuant to LCA/VVG? *

Do these contracts contain any medical exclusions?

Country of residence of the new insured person *

Start of insurance coverage *

Duration of insurance coverage *

Language for correspondence *

Does the request apply to another adult?

Does the request apply to a child?

Maternity insurance? *

Dental insurance? *

Areas of coverage? *

Message

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Basic insurance with an attractive premium

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