Quotation request for a pension insurance

Personal data

First name *

Date of birth (dd/mm/yyyy) *

Phone *

Last name *

Your reference

E-Mail *

Street/Nb. *

Postal code *

Location *

What is the amount you want to save annually?

N.B. the minimum amount of premium is 600€/year and the maximum tax allowance is 3 200€/year.

How often do you want to pay your premium?

annual
biannual
quarterly
monthly

Thank you for setting me an appointment to make a free assessment of my situation
Please provide me an offer

Would you like to benefit from personalised advice and information on the products and services of LALUX Group digitally?

Yes
No

Further information about our online forms.

* Required field