Allianz Generalvertretung Thomas Ehrhart in Frankenthal Pfalz

Mr.

Mrs.

First Name*

Last Name*

Date of birth [mm/dd/yyyy]*

Street*

Number*

Zip-code*

City*

E-Mail*

Phone

Profession*

Commencement of service [mm/dd/yyyy]*

Tax class

1

2

3

4

5

Children (according to wage tax card)

0

0,5

1

1,5

2

2,5

3

3,5

4

Church tax

yes

no

Type of health insurance

statutory

private

Contribution rate (in %)

Monthly gross salary

Number of salaries

Investment

25 €

40 €

50 €

75 €

100 €

125 €

150 €

175 €

200 €

225 €

276 € (4% BBG)

Other amount (in €)

Occupational disability insurance

Exemption in case of occupational disability

Occupational disability pension in the monthly amount of EUR

Body protection pension in the monthly amount of EUR

none

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Data required for calculating the advantage (tax/social security)

Church tax

Type of health insurance

I would like to invest the following amount

Occupational disability insurance

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