Forms AOV Inventory

AOV Inventory

Our inventory aims to provide insight into the steps to take to maintain your financial situation at the desired level during disability.

The information provided will be treated confidentially and we will use the data to provide appropriate advice regarding your disability insurance. You are free not to provide certain information for privacy reasons.

We, Alpina B.V., declare that we provide consumer advisory services within the meaning of the Financial Supervision Act.

Step 1 of 6

16%

Personal data

Your situation

Client/insured

Marital status*

Nuptial agreements

Community of property

Initials and last name of partner*

Date of birth partner*

Gender partner*

Man

Woman

Do you have children*

Yes

Initials and last name of child 1*

Date of birth child 1*

Studying child 1*

Yes

Child living at home 1*

Yes

Add second child

Yes

Initials and last name of child 2*

Date of birth child 2*

Studying child 2*

Yes

Child living at home 2*

Yes

Adding third child

Yes

Initials and last name of child 3*

Date of birth child 3*

Studying child 3*

Yes

Child living at home 3*

Yes

Adding fourth child

Yes

Initials and last name of child 4*

Child's date of birth 4*

Studying child 4*

Yes

Child living at home 4*

Yes

Your company

Company data

Company name*

Visiting address*

Legal form

Property

Yes

Founding date*

Chamber of Commerce number*

Website

Your objectives

Objective in taking out an AOV. Consider, for example:

Hiring substitute

Maintain standard of living

Minimal ability to meet obligations

Other, also consider future expenses, such as children's study costs

Explanation

Disability financing

Is the desire to use income from your partner when you are disabled? Take into account the possibility that your partner will work less if you are incapacitated.*

Yes

Is there a desire to use equity when you are incapacitated?*

Yes

Explanation

Your professional data

Profession

Ancillary profession

Training received

College or university education completed

Yes

Not applicable

Since when self-standing

Previously been self-employed

Yes

Business mileage per year

Number of working hours per week

Specification work indicated in percent

Administrative matters

Sale

Commercial

Manual labor

Working with hazardous materials

Working with machines

Working at height and/or above shoulder height

Lifting and/or stooping

Other

Total (must be 100%)

Supervising/leading/advising

Driving instruction

Sports Instruct

Surveillance

Teaching

Business travel domestic

Business travel abroad

Drivers inland, other than travel

Chauffeurs abroad, other than travel

Total (must be 100%)

Description of the actual work

Medical question

Notice:

Even if a medical problem occurs in the period between filling out the application and being accepted by the insurer, you must report it!
If you anticipate in the underwriting process that the health questions may be a hurdle, if you come from salaried employment, you can voluntarily continue coverage with the UWV for a fee under certain conditions!
If the medical questions are an obstacle then you can have the underwriting process stopped. The advantage of this is that there is no rejection or restriction.

Do you expect medical limitation(s) upon acceptance?

Yes

Leisure

Dangerous sports

Yes

Motorcyclist and under 23 years of age

Yes

Woodworking

Yes

Explanation

Risk appetite

To what extent is your current income adequate for your lifestyle?

Ample, we are saving heavily

Enough, we keep some

Reasonable, we don't keep anything

Inadequate

Do you expect to have sufficient funds to pay for your old-age provision?

Yes

Partially

Not at all

Do you expect to have sufficient funds in the event of disability or death?

Yes

Partially

Not at all

Is your partner willing to contribute financial resources to your disability?

Yes

Partially

Not at all

No partner

Can you live with financial risk?

I accept uncertainty and can live well with financial risk

I sometimes venture a guess but avoid great risks

I always look for as much certainty as possible

Are you willing to reduce your spending habits in case of financial setbacks?

I am willing to sell my house if necessary

I am willing to adjust my lifestyle downward

Not at all

How many months do you think you can carry the deductible in case of disability?

Explanation

Knowledge and experience

What do you know about tax and social legislation?

Very much

Enough

Weining

Nothing

What do you know about your income situation if you become disabled?

Very much

Enough

Few

Nothing

Why do you want to purchase disability insurance?

To what extent do you follow what is happening in the financial market?

Never

once a month

once a week

To what extent are you familiar with terms such as risk insurance, WIA, ANW?

Not

Moderate

Fair

Good

Explanation

Your income and expenses

Your income

Estimated profit from business next year

Insured

Partner (if applicable)

Gross profit last year

Insured

Partner (if applicable)

Gross profit 2 years back

Insured

Partner (if applicable)

Gross profit 3 years back

Insured

Partner (if applicable)

Gross annual income from salaried own business (management fee)

Insured

Partner (if applicable)

Gross annual income from employment elsewhere

Insured

Partner (if applicable)

Your accountant

Address accountant

Explanation

Your ability

Capital (total by component and value minus linked debt)

Are you prepared to use your assets in the event of disability?

Yes

Accrued value in life insurance policies

Accrued value in retirement

The following assets will not be considered in our advice

Bank/savings accounts

Investments

Value of own home

Value of other real estate

Other assets

Your charges

Mortgage/Rent/OZB

Insured

Partner (if applicable)

Gas, water and electricity

Insured

Partner (if applicable)

Municipal taxes

Insured

Partner (if applicable)

Alimony obligations

Insured

Partner (if applicable)

Until when (if applicable)

Insurance

Insured

Partner (if applicable)

Subscriptions

Insured

Partner (if applicable)

Car Costs

Insured

Partner (if applicable)

Telephone, television, internet

Insured

Partner (if applicable)

Shopping

Insured

Partner (if applicable)

Hobby, leisure

Insured

Partner (if applicable)

Any charges on loans

Insured

Partner (if applicable)

Until when (if applicable)

Other

Insured

Partner (if applicable)

At A.O., 1st year premium must be paid

Insured

Partner (if applicable)

Cost of old-age provision

Insured

Partner (if applicable)

Savings

Insured

Partner (if applicable)

Outstanding study costs children, PM

Insured

Partner (if applicable)

Total monthly charges

Insured

Partner (if applicable

Are there charges that are eliminated or reduced in the event of disability? If so, what are the charges/amounts involved?

Yes

Is the average gross annual income sufficient to meet your fixed expenses (past 3 years)?

Yes

When a person is incapacitated, additional costs may arise. Consider, for example, alternative transportation, aids in the home and additional healthcare costs. So it is important not to be "tight" financially!

What income will you still receive in the event of total disability?

Income from business

Yes

Payout from a policy

Yes

Commitment partner/partner

Yes

Wage commitment by B.V.

Yes

Rental income

Yes

Otherwise

Yes

What do you know about social legislation and what benefits are you entitled to when you are disabled?

Your future financial situation

My financial situation over the past 3 years was:

Sufficient to cover fixed expenses

Insufficient to cover fixed expenses

My financial situation over the past 3 years was inadequate because:

I can estimate my financial situation up to:

To my retirement

10 years

5 years

1 year

Otherwise

Explanation

Income estimate for future insured

Remains the same

Value fixed (inflation)

Increase

Decline

Income estimate for future partner (if applicable)

Remains the same

Value fixed (inflation)

Increase

Decline

Insured will work more/less in the future

Remains the same

Less

Partner will be working more/less in the future (if applicable)

Remains the same

Less

What change do you expect to see in your personal situation in the next 5 years?

Moving

Heritage

Receiving a donation

Children (childbearing/study)

Income (other job, own business, retirement)

Fiscal aspects

My knowledge and experience of the tax rules surrounding disability insurance is

Bad

Moderate

Sufficient

Good

Excellent

Details in brief:

Premium is deductible on income tax return
Consulting/management costs are not deductible
Benefit is taxable income, insurer withholds
On distribution to B.V., different tax regime applies, corporate income tax

Definition of income

Entrepreneur: The taxable profit from business, before entrepreneurial deduction and SME profit exemption and plus depreciation on business assets.
DGA: The taxable salary plus (part of) the sum of profit and depreciation. Depending on the insurer, a maximum of 80% to sometimes 90% of income is insurable.

Premiums according to these parameters

If you fill in the questions below we will check if this is in line with the above inventory and will provide you with an appropriate quote. Please feel free to contact with us if you need help completing the questions.

The desired insured amount for the first year of disability

Heading A

The desired insured amount for after the first year of disability

Heading B

Do you want to co-insure motorcycle risk?

Yes

This applies to insured persons under the age of 24.

Do you have a maximum budget when it comes to premium payment?

What is the desired contract length?

1 year

3 years

Until what age do you want to insure yourself?

After what period of disability do you want benefits to start?

14 days

30 days

60 days

90 days

180 days

1 year

2 years

If you want to take the entire first year at your own risk, do not enter an amount for the first year on disability.

Do you want the insured amounts to be indexed?

Yes

Do you want the benefit to be indexed?

Yes

Which index

CBS

From what percentage of disability should Section A pay out?

25%

35%

45%

55%

65%

80%

From what percentage of disability should section B pay out?

25%

35%

45%

55%

65%

80%

Do you desire sum or non-life insurance?

Sums

Damage

What criterion to use to determine degree of disability?

Professional

Appropriate

What payment term do you desire?

Monthly

Quarterly

Semi-annual

Annual

Do you wish to insure all risks or named risks?

Yes

In particular, insuring risk

Do you have a preference for an insurer?

Yes

Name preferred insurer

Pregnancy co-insured?

Yes

Not immediate coverage, sometimes only after 24 months.

Signature

By signing this inventory form, you understand that it may affect the accuracy and completeness of the advice and/or quotations to be issued and accept the consequences of this.

Initials and last name*

Date of birth*

Gender*

Man

Woman

Proof of identity*

Number on identification card*

Validity of identification card*

Nationality*

Phone number

Email address*

Private address*

Date*

Name*

I agree to the privacy statement.*

Yes

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