Personal information:

Source:

Destiny:

* All fields are required

Simple questions:

Yes No Yes No Yes No

Next Step

Enter the number of objects in your residence and the estimated value (for insurance), separated by rooms.

Inform the currency used in the estimated values (for insurance):

R$ - Real

US$ - Dolar

€$ - Euro

  • kitchen

    • Object
    • Amount
    • Value
    • Remove
    + add object
  • living & dining rooms

    • Object
    • Amount
    • Value
    • Remove
    + add object
  • bedrooms

    • Object
    • Amount
    • Value
    • Remove
    + add object
  • office

    • Object
    • Amount
    • Value
    • Remove
    + add object
  • other items

    • Object
    • Amount
    • Value
    • Remove
    + add object

Note: Maximum Length 500 haracters.

Fill in instructions

Please contact us if necessary.

01 Select the room
to expand the form.

02 Enter the number of items
and the average unit value.

03 Use the Other Items area if you need to add
a non-existing object in the lists suggested.

04 Click on the [x] button
to delet an item from the list.

Send