Quotation request form for easyPROTECT Discover

The student's first name *

The student's last name *

Student flat address

The student's birth date *

Phone number *

Email address *

Choice of guarantees

Civil liability & legal protection
Student flat
IT, Mobile & Audio
Medical emergencies
Assistance cover

Please select the options that reflect your situation *

New customer
Parents having a civil liability at LALUX
Parents having a home insurance (Performance) at LALUX

* Required field

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