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Income protection questionnaire (self-employed)

Your income protection study, in five minutes.

Answer what applies to you: only your contact details are required. No medical questions: if the insurer has any, it asks you itself, in confidence.

Fill it in online (5 min) Download the PDF
Income protection questionnaire (self-employed), ASSUDIRE
6 stepsabout 5 minutes
Step 1 of 6 · Youabout 5 min left

* Only your contact details are required

1. You
You1 / 6

The policyholder.

Why? Your contact details are used to call you back and to draw up the study in your name.

Title
Marital status
Status
2. Your business
Your business2 / 6

Your status and trade, as insurers classify them.

Why? Status, fund and trade decide what the compulsory scheme pays, and the price.

Your status
Compulsory scheme
Share of manual work
Over 20,000 km a year for work
Business based in France
3. Income and expenses
Income and expenses3 / 6

What must keep coming in if you cannot work.

Why? Benefits are based on declared income: understate it and you are left short.

€
€ / month
€ / month
4. Your current policies
Your current policies4 / 6

What already covers you, so you do not pay twice.

Why? To compare like with like, and spot gaps in cover.

Existing income protection policy
€ / month
Current cover
Madelin contract
5. Your needs
Your needs5 / 6

Why? To cover the real loss of income, without paying for extras.

Cover wanted
€ / day
Waiting period wanted
Tax framework
Payment
Start date wanted
€ / month
6. Documents to attach
Documents to attach6 / 6

Photos or scans are fine.

Why? With these documents, the quote becomes a firm proposal.

No medical information is requested here. The health questionnaire, if required, is sent to you directly by the insurer and stays confidential.

See daily sickness benefits (in French)

Reply within 24 working hours · No obligation · You receive a copy of your request

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