Intermédiaire en crédit

Partie 1 : Identité du demandeur

Généralités

Volet 1

Volet 1

Volet 2

Adresse de résidence

Adresse du siège social

Adresse du principal siège d'exploitation (adresse de correspondance)

Divers

Partie 2 : Renseignements généraux

Vos diplômes
Votre activité d'intermédiaire en crédit
Intermédiaire en crédit

Vos antécédents
Assurances

Responsabilité

Partie 3 : Responsabilité civile exploitation

(Cette extension ne s'applique pas aux intermédiaires en crédit à la consommation à titre accessoire.)
NB : Par personne occupée, on entend le dirigeant de l'entreprise, les préposés, les organes et associés actifs, le conjoint aidant. Les préposés sont les personnes rémunérées, les intérimaires, les stagiaires, les étudiants et les aides bénévoles.

Mentions spéciales

La proposition d'assurance n'engage ni le candidat preneur d'assurance ni l'assureur à conclure le contrat. Si dans les trente jours de la réception de la proposition, l’assureur ne vous a pas notifié, soit une offre d'assurance, soit la subordination de l'assurance à une demande d'enquête, soit le refus d'assurer, il s'oblige à conclure le contrat sous peine de dommages et intérêts. La signature de la proposition ne fait pas courir la couverture.

Sachant que la présente proposition sert de base au contrat qui interviendrait, le candidat preneur d'assurance certifie sincères les réponses et déclarations y consignées.

Le candidat preneur d'assurance déclare avoir connaissance des conditions de réalisation de l’assurance et affirme n’avoir caché aucun élément ayant une incidence sur l’appréciation du risque par l’assureur.

Le candidat preneur d'assurance n’ignore pas que la prime qui serait à payer sera nette de toute commission.


Protection de la vie privée

Les données communiquées peuvent être traitées par la compagnie en vue du service à la clientèle, de l'acceptation des risques, de la gestion des contrats et des sinistres ainsi que du règlement des prestations.

Toutes les informations seront traitées avec la plus grande discrétion.

Les personnes concernées peuvent connaître ces données et les faire rectifier et s’opposer gratuitement à leur traitement à des fins de direct marketing au moyen d'une demande datée et signée accompagnée d'une photocopie recto verso de la carte d'identité, adressée à la compagnie.


Route Debugger

Type in a url in the address bar to see which defined routes match it. A {*catchall} route is added to the list of routes automatically in case none of your routes match.

To generate URLs using routing, supply route values via the query string. example: http://localhost:14230/?id=123

: {culture}/{controller}/{action}

Route Data
KeyValue
culturefr-be 
controllerProposition 
actionIntermediaryCreditForm 
Data Tokens
KeyValue

All Routes
Matches Current Request Url Defaults Constraints DataTokens
False{resource}.axd/{*pathInfo}(null)(empty)(null)
FalseCMSPages/GetCMSVersion.aspx(null)(null)(null)
FalseCMSPages/GetCMSVersion(null)(null)(null)
Falsegetavatar/{avatarguid}/{filename}(null)avatarguid = CMS.AspNet.Platform.Routing.GuidRouteConstraint(null)
FalseCMSPages/Newsletters/GetEmailBrowserContent.ashx(null)(null)(null)
FalseCMSPages/GetAzureFile.aspx(null)(null)(null)
FalseCMSPages/Scheduler.ashx(null)(null)(null)
FalseCMSPages/GetMetafile.aspx(null)(null)(null)
Falsegetmetafile/{fileguid}/{filename}(null)fileguid = CMS.AspNet.Platform.Routing.GuidRouteConstraint(null)
FalseCMSPages/GetFile.aspx(null)(null)(null)
Falsegetimage/{guid}/{filename}(null)guid = CMS.AspNet.Platform.Routing.GuidRouteConstraint(null)
Falsegetattachment/{guid}/{filename}(null)guid = CMS.AspNet.Platform.Routing.GuidRouteConstraint(null)
Falsecms/getattachment/{guid}/{filename}(null)guid = CMS.AspNet.Platform.Routing.GuidRouteConstraint(null)
Falsegetattachment/{*pathandfilename}(null)(null)(null)
Falsecms/getattachment/{*pathandfilename}(null)(null)(null)
FalseCMSModules/ContactManagement/Pages/Tools/SalesForce/LeadOutboundMessageHandler.ashx(null)(null)(null)
Falsegetproduct/{skuguid}/{skuname}(null)skuguid = CMS.AspNet.Platform.Routing.GuidRouteConstraint(null)
FalseCMSPages/GetAmazonFile.aspx(null)(null)(null)
FalseCMSPages/GetLocalSharePointFile.ashx(null)(null)(null)
FalseCMSPages/GetSharePointFile.ashx(null)(null)(null)
FalseCMSPages/GetMediaFile.aspx(null)(null)(null)
Falsegetmedia/{fileguid}/{filename}(null)fileguid = CMS.AspNet.Platform.Routing.GuidRouteConstraint(null)
FalseKentico.FormBuilder/File/Get(null)(null)(null)
FalseKentico.Debug/RequestLog/{action}/{name}action = Get, controller = KenticoRequestLog, name = SQLQueries(empty)(empty)
FalseKentico.Debug/RequestLog/{action}action = GetAllCacheItems, controller = KenticoRequestLog(empty)(empty)
FalseKentico.Debug/RequestLog/{action}/{key}action = GetCacheItem, controller = KenticoRequestLog(empty)(empty)
FalseKentico.VirtualContext/{action}controller = KenticoVirtualContextAuthenticationaction = Authenticate|AuthenticationIframe(empty)
FalseKenticoCookiePolicyCheckcontroller = KenticoCookiePolicyDetection, action = Index(empty)(empty)
FalseKentico.Resource/Builder/Scripts/Localization/{cultureCode}.jscontroller = KenticoLocalizationScript, action = Script(empty)(empty)
FalseKentico.FormBuilder/Configuration/Setcontroller = KenticoFormBuilderConfiguration, action = Set(empty)(empty)
FalseKentico.FormBuilder/Configuration/Get/{formId}controller = KenticoFormBuilderConfiguration, action = Get(empty)(empty)
FalseKentico.FormBuilder/Markup/EditorRow/{identifier}/{formId}controller = KenticoFormComponentMarkup, action = EditorRowidentifier = Kentico.Forms.Web.Mvc.FormComponentIdentifierConstraint(empty)
FalseKentico.FormBuilder/Configuration/GetDefaultProperties/{identifier}/{formId}controller = KenticoFormComponentConfiguration, action = GetDefaultPropertiesidentifier = Kentico.Forms.Web.Mvc.FormComponentIdentifierConstraint(empty)
FalseKentico.FormBuilder/Metadata/GetAll/{formId}controller = KenticoFormComponentMetadata, action = GetAll(empty)(empty)
FalseKentico.FormBuilder/KenticoFormBuilderConfiguration/DefaultProperties/{typeIdentifier}/{action}controller = KenticoFormBuilderConfiguration, action = GetFormSectionDefaultProperties(empty)(empty)
FalseKentico.FormBuilder/FormSections/{typeIdentifier}/KenticoFormSectionPropertiesForm/{action}controller = KenticoFormSectionPropertiesForm, action = Index(empty)(empty)
FalseKentico.FormBuilder/Index/{formId}controller = KenticoFormBuilder, action = Index(empty)(empty)
FalseKentico.FormBuilder/FormSections/{typeIdentifier}/{controller}action = IndextypeIdentifier = Kentico.Forms.Web.Mvc.SectionIdentifierConstraint, controller = Kentico.Forms.Web.Mvc.SectionControllerConstraint(empty)
FalseKentico.FormBuilder/FormBuilderPropertiesPanel/GetPropertiesMarkup/{formId}controller = KenticoFormBuilderPropertiesPanel, action = GetPropertiesMarkup(empty)(empty)
FalseKentico.FormBuilder/FormBuilderPropertiesPanel/ValidateProperties/{formComponentInstanceIdentifier}/{formComponentTypeIdentifier}/{formId}/{formFieldName}controller = KenticoFormBuilderPropertiesPanel, action = ValidateProperties(empty)(empty)
FalseKentico.FormBuilder/FormBuilderPropertiesPanel/GetValidationRuleConfiguration/{formId}controller = KenticoFormBuilderPropertiesPanel, action = GetValidationRuleConfigurationMarkup(empty)(empty)
FalseKentico.FormBuilder/FormBuilderPropertiesPanel/ValidateValidationRuleConfiguration/{formComponentInstanceIdentifier}/{validationRuleIdentifier}/{formId}/{formFieldName}controller = KenticoFormBuilderPropertiesPanel, action = ValidateValidationRuleConfiguration(empty)(empty)
FalseKentico.FormBuilder/FormBuilderPropertiesPanel/GetVisibilityConditionConfigurationMarkup/{formId}controller = KenticoFormBuilderPropertiesPanel, action = GetVisibilityConditionConfigurationMarkup(empty)(empty)
FalseKentico.FormBuilder/FormBuilderPropertiesPanel/ValidateVisibilityConditionConfiguration/{formId}/{formFieldName}/{formComponentInstanceIdentifier}controller = KenticoFormBuilderPropertiesPanel, action = ValidateVisibilityConditionConfiguration(empty)(empty)
FalseKentico.FormBuilder/FormItem/Preview/{formId}/{itemId}controller = KenticoFormItem, action = PreviewItem(empty)(empty)
FalseKentico.FormBuilder/FormItem/Edit/{formId}/{itemId}controller = KenticoFormItem, action = EditItem, itemId = 0(empty)(empty)
FalseKentico.FormBuilder/FormItem/Submitcontroller = KenticoFormItem, action = Submit(empty)(empty)
FalseKentico.FormBuilder/ValidationRules/GetAllcontroller = KenticoValidationRuleMetadata, action = GetAll(empty)(empty)
FalseKentico.FormBuilder/FormFileUploader/Postcontroller = KenticoFormFileUploader, action = PostFile(empty)(empty)
FalseKentico.FormBuilder/FormFileUploader/Deletecontroller = KenticoFormFileUploader, action = DeleteTempFile(empty)(empty)
FalseKentico.PageBuilder/Widgets/{cultureCode}/{typeIdentifier}/{controller}/{action}(empty)controller = Kentico.PageBuilder.Web.Mvc.ComponentControllerConstraint`1[Kentico.PageBuilder.Web.Mvc.WidgetDefinition], typeIdentifier = Kentico.PageBuilder.Web.Mvc.ComponentIdentifierConstraint`1[Kentico.PageBuilder.Web.Mvc.WidgetDefinition], cultureCode = Kentico.Web.Mvc.Internal.SiteCultureConstraint(empty)
FalseKentico.PageBuilder/Sections/{cultureCode}/{typeIdentifier}/{controller}/{action}(empty)controller = Kentico.PageBuilder.Web.Mvc.ComponentControllerConstraint`1[Kentico.PageBuilder.Web.Mvc.SectionDefinition], typeIdentifier = Kentico.PageBuilder.Web.Mvc.ComponentIdentifierConstraint`1[Kentico.PageBuilder.Web.Mvc.SectionDefinition], cultureCode = Kentico.Web.Mvc.Internal.SiteCultureConstraint(empty)
FalseKentico.PageBuilder/Personalization/ConditionTypes/{typeIdentifier}/{controller}/{action}(empty)controller = Kentico.PageBuilder.Web.Mvc.ComponentControllerConstraint`1[Kentico.PageBuilder.Web.Mvc.Personalization.ConditionTypeDefinition], typeIdentifier = Kentico.PageBuilder.Web.Mvc.ComponentIdentifierConstraint`1[Kentico.PageBuilder.Web.Mvc.Personalization.ConditionTypeDefinition](empty)
FalseKentico.Components/{cultureCode}/{typeIdentifier}/{controller}/{action}(empty)controller = KenticoFormWidget, typeIdentifier = Kentico.FormWidget, cultureCode = Kentico.Web.Mvc.Internal.SiteCultureConstraint(empty)
FalseKentico.PageBuilder/KenticoPageBuilderConfiguration/Set/{pageId}controller = KenticoPageBuilderConfiguration, action = Set(empty)(empty)
FalseKentico.PageBuilder/KenticoPageBuilderConfiguration/ChangeTemplatecontroller = KenticoPageBuilderConfiguration, action = ChangeTemplate(empty)(empty)
FalseKentico.PageBuilder/KenticoPageBuilderConfiguration/Get/{pageId}controller = KenticoPageBuilderConfiguration, action = Get(empty)(empty)
FalseKentico.PageBuilder/KenticoPageBuilderConfiguration/DefaultProperties/{typeIdentifier}/{action}controller = KenticoPageBuilderConfigurationaction = (GetWidgetDefaultProperties|GetSectionDefaultProperties|GetPageTemplateDefaultProperties)(empty)
FalseKentico.PageBuilder/Forms/{typeIdentifier}/{controller}/{action}(empty)(empty)(empty)
FalseKentico.PageBuilder/Metadata/GetAllcontroller = KenticoComponentsMetadata, action = GetAll(empty)(empty)
FalseKentico.PageBuilder/KenticoLinkMetadata/GetLinkMetadatacontroller = KenticoLinkMetadata, action = GetLinkMetadata(empty)(empty)
FalseKentico.PageBuilder/Clipboard/{action}controller = KenticoPageBuilderClipboardaction = (Get|Store)(empty)
FalseKentico.PageBuilder/PageTemplates/GetFilteredcontroller = KenticoPageTemplatesViewModel, action = GetFiltered(empty)(empty)
FalseKentico.PageBuilder/PageTemplates/SelectorDialogcontroller = KenticoPageTemplatesSelectorDialog, action = Index(empty)(empty)
FalseKentico.Components/Dialogs/{controller}/{action}action = Indexcontroller = (KenticoMediaFilesDialog|KenticoPageSelectorDialog|KenticoAttachmentsDialog)(empty)
FalseKentico.Components/Selectors/{Controller}/{ComponentType}/{ComponentIdentifier}/{PropertyName}/GetItemsaction = GetItemscontroller = (KenticoObjectSelector|KenticoGeneralSelector)(empty)
FalseKentico.Uploaders/{controller}action = Uploadcontroller = (KenticoMediaFilesUploader|KenticoAttachmentsUploader)(empty)
FalseKentico.Components/ComputerVision/GetDescriptionaction = GetDescription, controller = KenticoComputerVision(empty)(empty)
FalseKentico.Activities/KenticoActivityLogger/Logcontroller = KenticoActivityLogger, action = Log(empty)Namespaces = Kentico.Activities.Web.Mvc
FalseKentico.Resource/Activities/KenticoActivityLogger/Logger.jscontroller = KenticoActivityLogger, action = Script(empty)Namespaces = Kentico.Activities.Web.Mvc
FalseCMSModules/Newsletters/CMSPages/Track.ashx(empty)controller = , action = (null)
FalseCMSModules/Newsletters/CMSPages/Redirect.ashx(empty)controller = , action = (null)
False{*Kentico.AlternativeUrls.Url}(empty)Kentico.AlternativeUrls.Url = Kentico.Content.Web.Mvc.Routing.AlternativeUrlConstraintNamespaces = Kentico.Content.Web.Mvc.Routing
False{*Kentico.PageUrlPaths}(empty)Kentico.PageUrlPaths = Kentico.Content.Web.Mvc.Routing.PageUrlPathConstraint(empty)
False{*Kentico.PageFormerUrlPaths}(empty)Kentico.PageFormerUrlPaths = Kentico.Content.Web.Mvc.Routing.PageFormerUrlPathConstraint(empty)
False{culture}/Article/{*nodealiaspath}controller = Article, action = Indexculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
Falseapi/{culture}/News/GetNewscontroller = News, action = GetNewsculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
False{culture}/News/{nodealias}controller = News, action = Detailculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
FalseCmsdesk/{action}controller = Cmsdesk, action = index(empty)(empty)
FalseCmsdesk/logs/detail/{id}controller = Cmsdesk, action = LogDetail(empty)(empty)
False{culture}/Info/{*nodeAlias}controller = Info, action = Indexculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
False{culture}/Subscription/Subscribe/{*newslettersCodeName}controller = Subscription, action = Subscribeculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
False{culture}/PrimeCalculator/{*nodeAlias}controller = PrimeCalculator, action = Indexculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
FalsePrimeCalculator/Calculatecontroller = PrimeCalculator, action = Calculate(empty)(empty)
False{culture}/Content/{*nodeAlias}controller = Content, action = Indexculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
True{culture}/{controller}/{action}controller = Home, action = Indexculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
False{controller}/{action}controller = Home, action = Index, culture = fr-BEculture = Sobegas.Features.Shared.Infrastructure.SiteCultureConstraint(empty)
True{*url}controller = Errors, action = NotFound(empty)(empty)
True{*catchall}(null)(null)(null)

Current Request Info

AppRelativeCurrentExecutionFilePath is the portion of the request that Routing acts on.

AppRelativeCurrentExecutionFilePath: ~/fr-be/Proposition/IntermediaryCreditForm