Deckungsaufgabe Tierhalterhaftpflichtversicherung Für

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Deckungsaufgabe Tierhalterhaftpflichtversicherung Für Bitte dieses Feld nicht beschriften Versicherer: VOLKSWOHL BUND Sachversicherung AG · Südwall 37 – 41 · 44137 Dortmund 33/ Tel. 02 31/54 33 151 · Fax 02 31/54 33 490 · E-Mail: [email protected] Antrag aufgenommen durch: Deckungsaufgabe Vertriebspartnerkennung: Tierhalterhaftpflichtversicherung für Makler / Bei ist Zutreffendes anzukreuzen. Antragsteller/-in: männlich weiblich Titel Name, Vorname Straße, Haus-Nr. PLZ, Wohnort Geburtsdatum Staatsangehörigkeit Telefon Telefax E-Mail Antragsart: Neuantrag Ersatzantrag zu Versicherungsschein-Nr. Vertragsgrundlagen gemäß dem gewählten Leistungsumfang: Haftpflichtversicherung für Tierhalter von Hunden und/oder Reit- und Zugtieren, Esel, Ponys, Kutschrisiko Hundehalter 60Plus - Allgemeine Versicherungsbedingungen für die Haftpflichtversicherung (AHB) – Fassung Januar 2008 VBS H 2 306 01.2008 - Besondere Bedingungen, Risikobeschreibungen und Erläuterungen für die Haftpflichtversicherung der Tierhalter aus privater Tierhaltung – Fassung Oktober 2009 VBS H 2 2212 10.2009 Besondere Vereinbarungen: Bitte die Vertragsinformationen zusammen mit dem Versicherungsschein dem Antragsteller als Service Mündliche Vereinbarungen zuschicken. haben keine Gültigkeit. SEPA-Lastschriftmandat VOLKSWOHL BUND Sachversicherung AG, Südwall 37 - 41, 44137 Dortmund, Gläubiger-Identifikationsnummer: DE 83ZZZ00000141065 Mit diesem Formular wird die VOLKSWOHL BUND Sachversicherung AG zum Lastschrifteinzug ermächtigt. Diese wird den Kontoinhaber rechtzeitig vor dem Einzug einer SEPA-Lastschrift informieren und die Mandatsreferenznummer mitteilen. Daten des Kontoinhabers (nur auszufüllen, falls nicht Antragsteller) Herr Frau Firma Name, Vorname/Firma Straße, Haus-Nr. PLZ, Ort Die VOLKSWOHL BUND Sachversicherung AG wird ermächtigt, Zahlungen von nachstehendem Konto mittels Lastschrift einzuziehen. Zugleich wird das Kreditinstitut angewiesen, die von der VOLKSWOHL BUND Sachversicherung AG auf das Konto gezogenen Lastschriften einzulösen. Der Kontoinhaber ist damit einverstanden, dass die VOLKSWOHL BUND Sachversicherung AG, falls erforderlich, spätestens 5 Kalendertage vor dem SEPA-Lastschrifteinzug hierüber eine Information an ihn versendet. Hinweis: Der Kontoinhaber kann innerhalb von 8 Wochen, beginnend mit dem Belastungsdatum, die Erstattung des belasteten Betrags verlangen. Es gelten dabei die mit dem Kreditinstitut vereinbarten Bedingungen. Die „Hinweise zum Datenschutz” wurden mir ausgehändigt. Art der Zahlung: wiederkehrende Lastschrift IBAN DE BIC Kreditinstitut Datum, Unterschrift Wichtig: Das Mandat ist nur mit des Kontoinhabers 䘤 Datum und Unterschrift gültig! VBS H 1 THV 1 D 05.2018 Seite 1 von 3 Bitte dieses Feld nicht beschriften Deckungsaufgabe Private Tierhalterhaftpflichtversicherung für Makler HAN03 33/ Versicherungsdauer: Hat der Vertrag eine Laufzeit von mindestens einem Jahr, verlängert er sich automatisch um jeweils ein Jahr, wenn nicht dem Vertragspartner spätestens drei Monate vor dem Versicherungsbeginn mittags 12 Uhr Ablauf des jeweiligen Versicherungsjahres eine Kündigung in Textform (z. B. E-Mail, Telefax oder Brief) zugegangen ist. Bei einer Vertragsdauer von mehr als drei Jahren kann Versicherungsablauf mittags 12 Uhr der Vertrag vom Versicherungsnehmer schon zum Ablauf des dritten Jahres oder jedes darauf folgenden Jahres mit oben genannter Frist gekündigt werden. Zahlungsweise: jährlich halbjährlich (Zuschlag 3%) vierteljährlich (Zuschlag 5%) monatlich (Zuschlag 8%) – nur mit Einzugsverfahren Bitte beachten Sie die ,,Hinweise zur Verletzung der vorvertraglichen Anzeigepflicht”. Die Nichtbeachtung kann Ihren Versicherungsschutz gefährden. Frage nach gefahrerheblichen Umständen (Risikofrage): Ist der Antragsteller Eigentümer und Halter der Tiere? (wenn nein, kein Vertragsabschluss möglich) ja nein Versicherungssummen: Die Antragstellung ist nur möglich, wenn alle pauschal für Personen-, Sach- und Vermögensschäden 10.000.000 EUR vom Antragsteller gehaltenen Hunde, Pferde, Ponys und Esel bei der VOLKSWOHL BUND Im Rahmen der Pauschaldeckung für Personen-, Sach- und Sachversicherung AG versichert werden. Vermögensschäden, z. B.: Die maximale Entschädigungsleistung ist je Mietsachschäden (außer Stallungen, Boxen und Reithallen) 10.000.000 EUR Versicherungsjahr auf das Doppelte dieser Mietsachschäden an Stallungen, Reithallen und Weiden* 10.000 EUR Summen begrenzt. Für Mietsachschäden ist Mietsachschäden an Pferdetransportanhängern* 5.000 EUR die Versicherungssumme auch die maximale Schadenminderungskosten bei ungewollten Deckakten EUR Entschädigungsleistung je Versicherungsjahr. *Gilt nicht für Hundehalterhaftpflicht 60Plus; die Selbstbeteiligung an diesen Mietsachschäden beträgt je Schadenfall 20 %, mindestens 100 EUR. Hunde und Hunde 60Plus (Rassenliste s. Seite 3): Anzahl aller privat gehaltenen Hunde: Hunderasse/n: Chipnummer/n: Beitrag 1. Hund Anzahl x Beitrag je weiterer Hund Beitrag Hunderasse/n nicht Kategorie A o. B EUR + x EUR = EUR Reit- und Zugtiere: Anzahl aller gehaltenen Pferde: Beitrag 1. Pferd Anzahl x Beitrag je weiteres Pferd (einschließlich: Zucht-/Aufzucht- pferde, Gnadenbrotpferde) EUR + x EUR = EUR Anzahl x Beitrag je Tier Zucht-/Aufzuchtpferde (ohne Reitrisiko) x EUR = EUR Gnadenbrotpferde x EUR = EUR Ponys (Rassenliste s. Seite 3): Ponyrasse/n: Anzahl aller gehaltenen Ponys: x EUR = EUR Esel: Gemeinschaft mit anderen Huftieren Anzahl aller Esel in Gemeinschaft: x EUR = EUR allein gehalten Anzahl aller Esel allein gehalten: x EUR = EUR Beitrag je Kutsche Kutschrisiko: Anzahl aller Kutschen: x EUR = EUR Zwischensumme EUR Versicherungssteuer EUR Jahresbeitrag EUR Beitrag gemäß Zahlungsweise EUR Vorversicherungen/Vorschäden: Bestehen oder bestanden gleichartige Versicherungen für den Antragsteller und/oder Ehe-/Lebenspartner oder wurden sie beantragt? ja nein Sind in den letzten fünf Jahren Schäden (auch nicht von einem Versicherer regulierte Schäden) eingetreten? ja nein Gesellschaft Versicherungs-Nr. gekündigt/ungekündigt/abgelehnt durch Vorschäden (Anzahl/Höhe in EUR) Wir möchten Sie darauf hinweisen, dass Sie als Antragsteller verpflichtet sind, uns diese Fragen vollständig und wahrheitsgemäß zu beantworten, da wir die Angaben im Rahmen der Risikoprüfung benötigen. Zur Überprüfung und Ergänzung Ihrer Angaben kann ein Datenaustausch mit anderen Versicherern erforderlich werden. Ich handele im Auftrag des Antragstellers. Die Maklervollmacht hierfür ist beigefügt/liegt mir vor. Ort/Datum Unterschrift des bevollmächtigten Maklers VBS H 1 THV 1 D 05.2018 Seite 2 von 3 Deckungsaufgabe Private Tierhalterhaftpflichtversicherung für Makler Liste der Hunderassen Hunderassen Kategorie A: Für die Versicherung folgender Hunderassen ist eine Anfrage in der Direktion erforderlich: American Bulldog, Akbas, Berger de Beauce (Beauceron), Berger de Brie (Briard), Bullmastiff, Cane Corso, Carpatin, Dobermann, Dogo Canario (Alano), Estrela-Berghund, Kangal, Karakatschan, Karshund, Kaukasischer Owtscharka, Komondor, Kraski Ovcar, Kuvasz, Liptak (Goralenhund), Maremanner Hirtenhund, Mastiff, Mastin de los Pirineos, Mioritic, Mittelasiatischer Owtscharka, Polski Owczarek Podhalanski, Pyrenäenberghund, Raffeiro do Alentejo, Rottweiler, Sarplaninac, Slovenski Cuvacz, Südrussischer Owtscharka, Tibetanischer Mastiff, Tornjak und deren Mischlinge. Hunderassen Kategorie B: NICHT versicherbar und trotz Antragstellung nicht versichert ist die Haftpflicht aus der Haltung folgender Hunderas- sen: American Staffordshire Terrier, Bandog, Bordeaux-Dogge, Bullterrier, Dogo Argentino, Fila Brasileiro, Mastino Espanol, Mastino Napoletano, Pitbull-Ter- rier, Römischer Kampfhund, Staffordshire Bullterrier, Tosa Inu und deren Mischlinge. Werden Hunde der Kategorie B allein oder zusammen mit Hunden anderer Rassen gehalten, kann der Antrag von uns nicht angenommen werden. Für die Hunderassen der Kategorie B gelten nicht die Bestimmungen über den Versicherungsschutz gemäß Ziffer 3.1 (2) AHB (Erhöhungen und Erweiterungen), nicht Ziffer 3.1 (3) und Ziffer 4 AHB (Vorsorge-Versicherung) und nicht die „Besonderen Bestimmungen für den Vertrag über vorläufige Deckung“. Nachfolgende Rassen können zum Pony-Tarif versichert werden: Abaco-Wildpferd, Abessinier, Achetta, Aegidienberger, Ainos-Pony, Albaner, American Classik Shetlandpony, American Cream Draft Horse, American Indian Horse, American Miniature Horse, American Paint Pony, American Shetland Pony, American Walking Pony, American Welara pony, Andino, Anglo-Araber, Arenberg-Nordkirchner Pony, Arravani, Assateague-Pony, Asturcon-Australian Pony, Aveligneser (Italienischer Hafinger), Azoren-Pony, Baise, Balearen Pony, Bali Pony, Banker-Pony, Bardigiano, Barock-Pony, Baschkire Basuto-Pony, Batak Pony (Deli Pony), Belgisches Reitpony, Bergmann Pony, Bhutia, Bosniake, Bosnisches Gebirgspferd, British Riding Pony, British Spotted Pony, Burenpferd, Carmague, Cavallino di Monterufoli, Cayuse Pony, Cheju Pony, Chickasaw Pony, China Pony, Chincoteague, Cob, Connemara-Pony, Criollo, Dales-Pony, Dartmoor-Pony, Deutsches Classic- Pony, Deutsches Part-Bred Shetland Pony, Deutsches Reitpony, Dülmener (Dülmener Wildpferd / Grubenpony), Edelblut (Arabo-Haflinger), Exmoor- Pony, Falabella, Färöerpony, Fell Pony, Finnischer Klepper,Fjord, Flores Pony, Galiceno Pony, Garrano Gotland-Pony, Hackney, Haflinger, Highland-Pony, Hokkaido, Holländisches Reitpony, Huzule, Isländer, Java, Kasak, Kaspisches Gebirgspferd, Kaspisches Kleinpferd, Knabstrupper, Konik, Kurdisches Halbblut, Landais Pony, Lehmkuhlener Pony, Lewitzer, Liebenthaler Pferd, Mbayer, Mérens, Minishetlandpony, Misaki, Mongolen Pony, Mongolisches Wildpferd, Mpar, Mustang, Nanfan, Neufundland Pony, New-Forest-Pony, Niederländisches Reitpony, Nigerianisches Pony, Norwegisches Fjordpferd, Palomino, Panjepferd, Paso Fino, Paso Peruano, Pindos Pony, Pinto, Polo- Pony, Pony of the Americas, Pottok-Pony, Przewalski-Pony, Quba, Riwoque, Rocky Mountain Horse, Sable Island Pony, Sandelholz-Pony, Sardisches Pony, Schwarzwälder Fuchs, Schweike, Senner, Shetlandpony, Skyros Pony, Sorraia, Spiti, Sumba, Taishu, Tarpan, Tibet, Tigerscheckpony, Timor, Tinker, Tokara Pony, Wjatka-Pony, Welsh Cob, Welsh Mountain, Welsh Partbred, Welsh Riding Pony, Welsh-Pony, Yonaguni Pony, Zamaitukapony VBS H 1 THV 1 D 05.2018 Seite 3 von 3.
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