1. Subscriber




  • Male
  • Female
  • Yes
  • No
  • Bachelor/single
  • Cohabitant
  • Married
  •  
  • Widow(er)
  • Separated
  • Divorced
  • French
  • Dutch
  • English
2. Choice of formula

Overview monthly premiums

Compensation payable from 30% disability Compensation payable from 5% disability
Age ≤ 65 Age > 65 Age ≤ 65 Age > 65
Formule 1: yourself 15 EUR 18 EUR 20 EUR 24 EUR
Formule 2: yourself + entire family 27 EUR 29 EUR 36 EUR 41 EUR

Select your formula:

  • I want to subscribe an insurance for myself and opt for the formula with compensation payable from 5% disability
  • I want to subscribe an insurance for myself and opt for the formula with compensation payable from 30% disability
  • I want to subscribe an insurance for me and my family and opt for the formula with compensation payable from 5% disability
  • I want tot subscribe an insurance for me and my family and opt for the formula with compensation payable from 30% disability

All data supplied may be processed by Vanbreda Risk & Benefits for the purposes of customer services, risk acceptance, contract management and claims handling. Such data may be communicated to companies with which they have relations, in order to provide the most suitable services. The individuals concerned consent to the given data being processed to the extent necessary for contract acceptance, management and performance by the handlers acting within the context of the contract. This processing is provided for by the Belgian Privacy Protection Law of December 8, 1992. All information will be handled with the utmost discretion.