Civil status modification | Generali

Reason for the modification of the civil status:

Fields marked * must be completed.

Civil status*

Marriage

Divorce

widowed

Old details

Title*

Mr

Ms

First name*

Please enter your first name.

Surname*

Please enter your surname.

Street*

Please enter your street name.

House number

Postcode*

Please enter a valid postcode.

Place of residence*

Please enter a valid place of residence.

Land*

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Telephone (home)

Please enter your home telephone number.

Telephone (work)

Please enter a valid work telephone number.

E-Mail*

Please enter a valid e-mail address.

New details

Title

Mr

Ms

First name

Please enter your first name.

Surname

Please enter your surname.

Street

Please enter your street name.

House number

Postcode

Please enter a valid postcode.

Place of residence

Please enter a valid place of residence.

Land

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Telephone (home)

Please enter your home telephone number.

Telephone (work)

Please enter a valid work telephone number.

E-Mail

Please enter a valid e-mail address.

Valid from*

Concerned policies (number only)

Policy 1

Policy 2

Policy 3

Policy 4

Message

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