I confirm that my driving licence has not been withdrawn in the past five years.
I confirm that, during the past five years, neither Baloise nor any other company has refused my application for insurance, terminated a contract or imposed special conditions on the basis of claims cases.
By submitting the form, I declare that I have answered all the questions truthfully and completely, that I have read the Product Information and that I agree to the general Terms and Conditions (PDF).
By submitting this form, I agree to the additional provisions for insurance contracts subjects to the law of Liechtenstein (German only).
By submitting this form, I agree to insurance transactions being conducted electronically and to paper documents being dispensed with. Upon conclusion of the contract, I will obtain automatic access to the myBaloise customer portal.