The Insurance Declaration Form is a crucial document in the Belgian insurance industry, required whenever an individual or organization seeks to obtain or modify insurance coverage. This document, regulated under Belgian law and the Insurance Act of 2014, serves as the primary source of information for insurers to assess risks and determine appropriate coverage terms. The form must be completed with accurate and complete information about the subject matter of insurance, risk factors, and relevant historical data. It typically includes various sections depending on the type of insurance (life, property, health, etc.) and requires detailed disclosures to ensure proper risk assessment. The declarations made in this form become the basis for the insurance contract, and any misrepresentation can affect the validity of the policy. The document must comply with Belgian language laws and GDPR requirements, particularly regarding the handling of personal data.
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1. Personal Information: Policyholder's details including full name, address, date of birth, national registration number, and contact information
2. Insurance Type: Specification of the type of insurance being declared (e.g., life, health, property, vehicle)
3. Risk Details: Detailed information about the subject of insurance (property details, vehicle information, health conditions, etc.)
4. Previous Insurance History: Declaration of previous insurance policies, claims history, and any cancellations or refusals
5. Financial Information: Relevant financial details required for the insurance assessment
6. Declaration Statements: Standard statements confirming the truthfulness of information provided and understanding of obligations
7. Privacy Notice: GDPR-compliant statement about data processing and privacy rights
8. Signature Section: Space for date, signature, and confirmation of understanding
1. Medical Questionnaire: Detailed health-related questions, required for health or life insurance declarations
2. Property Details: Specific section for property insurance including building characteristics and security measures
3. Vehicle Information: Detailed vehicle specifications and usage patterns for auto insurance
4. Beneficiary Designation: Required for life insurance to specify primary and secondary beneficiaries
5. Professional Activities: Required for professional liability or income protection insurance
6. Additional Insured Parties: Section for declaring other individuals to be covered under the policy
7. International Coverage: Required when insurance coverage extends beyond Belgian borders
1. Schedule A - Premium Calculation: Detailed breakdown of premium calculations and payment terms
2. Schedule B - Coverage Details: Specific limits, deductibles, and conditions of coverage
3. Schedule C - Risk Assessment: Detailed evaluation of declared risks and corresponding ratings
4. Appendix 1 - Supporting Documents: List of required supporting documents (e.g., medical reports, property valuations)
5. Appendix 2 - Terms and Conditions: Standard insurance terms and conditions as required by Belgian law
6. Appendix 3 - Claims Procedure: Detailed procedure for filing and processing claims
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