Care Concept AG
– Policy Department –
P. O. Box 33 01 51

53203 Bonn


Fax.: 0800 977 35 35   |   e-Mail:  info@care-concept.de



 Extension of Insurance Policy
Policy number

Policyholder
Insured person
born on:

Contact information
| | - |

Dear Sir or Madam,


I hereby request an extension of months for the above-mentioned insurance policy. The
policy was originally to expire on ... .


Please send me a written confirmation of the policy extension.


Faithfully yours,

   



________________________________
Policyholder’s signature