7406 Antrag englisch WBS 7407 - SEATCupra.net

Please, stick together the complete form and send it to: ADAC e.V., 81015 München
By fax: 01805302928 (0.12 F/min.)
Yes, I would like to become an ADAC member
Mr Mrs/Ms
▼ street / number
▼ phone (daytime)
▼ name / surname
▼ post code ▼ city
▼ e-mail (these details are optional and may be revoked any time)
▼ date of birth married / living in a partnership:
D D M M Y Y
▼ name / surname partner / spouse
I am already an ADAC member and apply for following modifications
▼ name / surname primary member
yes no
▼ Please select your membership and complete
ADAC membership
ADAC membership 44,– H 60,– H
Severely disabled from 50%
(of invalidity, please attach copy of degree)
Young adults
(student / apprentice, under 27)
▼ expected end of education / training
M M Y Y
Important! If a membership exists already, always indicate
name and membership number of the primary member.
Change to
ADACPlusMembership
Free cover for children
▼ name / surname child
single membership
annual fee*
▼ fax
Do you have a credit card?
yes no
I am already an ADAC member and apply for the ADACPlusMembership
incl. all ADAC-Euro-Schutzbrief 1) benefits at additional 34.– H per year.
ADAC Partner Membership for ADAC membership 16.– H /ADACPlusMembership 19.– H
(depending on primary membership) incl. benefits of the En-routeCover
▼ name / surname partner / spouse
2)
ADAC motorwelt magazine (available in German language only):
yes no
ADACPlusMembership incl. ADAC-Euro-Schutzbrief benefits1) single membership PartnerPlusPackage
annual fee* annual fee*
ADACPlusMembership 78,– H 97,– H
Severely disabled from 50%
(of invalidity, please attach copy of degree)
Young adults
(student / apprentice, under 27)
▼ expected end of education / training
M M Y Y
67,– H
67,– H
86,– H
86,– H
incl. insurance benefits of the
En-routeCover2) ▼ membership number
m. f.
▼The PlusMitgliedschaft shall start on
▼date of birth partner / spouse
ADAC Youth Membership (from 15 th to 18 th birthday incl. accident and private liability insurance).
Yes, I want the free cover for my children until their 18 th birthday.
▼ date of birth
▼ name / surname child m. f. ▼ date of birth
The ADAC Youth Membership is a regular membership from the 18 th birthday. From the 15 th to 18 th birthday a free accident 1) and private liability insurance 3) are included.
Entitlement to services of the club, specially of the ADAC breakdown and accident assistance,
is governed by the terms and conditions of ADAC e.V. Entitlement to the benefits of the Schutzbrief
insurance, the insurance benefits under the ADAC-En-routeCover, the accident and private
liability insurance for ADAC Youth Members is governed by the relevant group insurance
conditions including the application and insurance policy. Please note the attached “Important
Information about the ADAC Membership”. Within 2 weeks from the day of receipt of your
Data privacy agreement: I agree that the personal data
may be processed according to the data privacy agreement
clause stated overleaf.
0 hrs
membership documents you may revoke your application to ADAC in writing towards
ADAC e.V., MVS, Am Westpark 8, 81373 München (mailing date). If you make use of the
ADAC breakdown and accident assistance services prior to the expiration of the time
limit for revocation, revocation of your ADAC membership is no longer possible.
This application form and all further information in English are to given initial assistance.
All further contractual documents and correspondence will be provided in German.
▼ date ▼ Signature
Please enter your bank details for direct debit of the membership fee. The ADAC Partner Membership fee will be debited to one account (primary member's account).
▼ bank code ▼ account number ▼ name and location of the bank
▼ account holder (complete only if account holder and applicant are not the same person)
▼ date ▼ signature
D D M M Y Y
✘
33,– H
33,– H
PartnerPackage
annual fee*
49,– H
49,– H
*plus joining fee 4,– H (not charged for automatic debit)
D D M M Y Y
✘
Your advantage:
Save 4.– H enrolment fee, direct debit of your annual fee.
Insurer:
1)ADAC-Schutzbrief Versicherungs-AG 2)ADAC-Schutzbrief Versicherungs-AG, ADAC-Rechtsschutz Versicherungs-AG, ARISA Assurances S.A. 3)ARISA Assurances S.A.
ADAC
▼date of birth partner / spouse
D D M M Y Y
D D M M Y Y
D D M M Y Y
D D M M Y Y
D D M M Y Y
WBS 7407

Important Information about the ADAC Membership
A. ADAC Breakdown and Accident Assistance for ADAC Members
(As of 1 September 2004)
1. Which services are you entitled to after a breakdown or accident in Germany?
■ Breakdown or accident assistance (from your doorstep) at the site of the incident by an ADAC
road patrol or an ADAC-appointed contractor in order to make the vehicle mobile. Cover up to
200.– F including outward and return trip and all transported small parts. A breakdown is defined
as a braking, operating damage or breakage. An accident is a sudden external event damaging
the vehicle with mechanical force.
■ Towing (from your doorstep) directly from the site of the incident by an ADAC contractor to the
nearest suitable garage/authorised garage or to a requested place situated in equal distance.
Cover up to 200.– F and necessary storage and security fees. Additional cover up to 200.– F for
the separate transport of luggage and cargo (no animals and commercial goods), if they cannot
be transported with the vehicle.
■ Off-road recovery by an ADAC contractor, if the vehicle has come off the road and can only be
made ready for towing or onward journey with considerable technical effort. Full cover. The same
applies to luggage and cargo, but not to animals and commercially transported goods.
■ As an ADAC member you are personally entitled to ADAC assistance services. This right cannot
be assigned to third parties. There is no right to reimbursement of costs incurred. The club
service is not free of charge, if a right to claim compensation from third parties exists, or the
same services are provided repeatedly because of the same cause or the damage is caused out
of gross negligence or deliberately.
Expressly call for assistance by ADAC, also when calling from an emergency call box on the
motorway or a police station, and always provide ADAC membership identification. Your statements
regarding the claim have to be complete and must be supported by adequate documentation.
2. Which vehicle is covered?
The vehicle driven by you – as an ADAC member holding a driver's licence – at the time of the
incident, if immobilised on a public road in Germany due to a breakdown or accident. The cover
extends to motor vehicles not requiring registration. It includes the attached trailer with no more
than one axle. Axles with a distance of less than 1.00 m between them are regarded as one axle.
Covered are vehicles with no more than 9 seats (including the driver's seat) up to a width of 2.55 m,
up to a total length of 10 m, up to a height of 3 m and up to a gross weight of 3.5 t and motor homes
listed on the registration up to a width of 3.2 m and up to a gross weight of 7.5 t. All dimensions
indicated included the load. Not covered are: scrap value vehicles, vehicles (or their cargo),
confiscated or taken into custody by the police, vehicles used for commercial transport of persons
(except taxis) vehicles during test and delivery drives (red plates) and non-registered vehicles.
3. When does your ADAC Membership and cover begin?
Your ADAC Membership starts in the months of receipt of your application, if no other month has
been expressly agreed. The membership becomes effective as soon as you receive your membership
card and further documents regarding your membership (e.g. “terms and conditions”).
Insurance cover starts at 0.00 hrs on the day after the application for ADAC membership is received,
if the first membership fee is paid. If you accepted an ADAC offer for the purchase of an ADAC
membership, your entitlement to benefits does not start before 0.00 hrs on the day following your
acceptance of the offer. Claims originating before the commencement date shall not be covered.
Cover ends upon the expiration of the membership.
4. When do you have to pay the membership fee?
The membership fee has to bee paid in advance. The renewal fees come due on the first day of the
month, in which a new membership year starts. There is no right to benefits for claims arising after
the deadline mentioned in the reminder, if the membership fee has not been paid. Membership
payments made later will not create cover retroactively.
5. In the case of any default in performance of obligation, ADAC will assume liability, if ADAC or
its contractor acted deliberately or with gross negligence, unless essential contract obligations or
physical injury are concerned. If your vehicle is transported, ADAC will assume liability according to
the legal provisions of the German Commercial Code (HGB) applying to carriers in the version valid
at the time of the claim, exceeding the legal limit and up to 512,000.– F
B. ADACPlusMembership
(As of 1 September 2004)
1. Which benefits are you entitled to?
■ ADAC breakdown or accident assistance
■ Schutzbrief benefits: Your club signed a group insurance contract with ADAC-Schutzbrief Versicherungs-AG,
81362 Munich in your favour, so you can place your claims directly with them.
The group insurance conditions of the ADAC-Schutzbrief Versicherungs-AG for the ADACPlus-
Membership apply.
World-wide Schutzbrief services and benefits for you and your family: medical repatriation,
accommodation costs, costs of hospital visits, children escort service, costs of premature return,
assistance in special emergencies, repatriation of pets, medication and spectacles dispatch
(only abroad), assistance after loss of travel documents (only abroad), assistance with language
problems/interpreters service (only abroad), alternative driver service (only in Europe).
Europe-wide Schutzbrief services and benefits, if your vehicle is immobilised: breakdown and
accident assistance, assistance with lost or defective car keys, towing, off-road recovery,
accommodation costs, transfer costs, costs of home journeys (rail, air, hire car) vehicle recovery,
passenger transport, pick-up service (only in Germany), spare parts dispatch (only to foreign
countries), payment of vehicle customs clearance and scrapping fees (only abroad).
Letters of credit: ADAC-Schutzbrief Versicherungs AG provides assistance in financial difficulties
abroad: AIT letters of credit, car hire credit voucher, accommodation credit voucher, credit
voucher for rail and air tickets, lawyer's and medical expense credit voucher, banking
arrangements and assistance in emergencies. The advanced amounts have to be paid back to
ADAC-Schutzbrief Versicherungs-AG within 14 days of receipt of invoice. If a third party is liable
to provide benefits following a claim, it will be charged for the costs. If you report this claim to
ADAC-Schutzbrief Versicherungs-AG, it will provide the service according to its terms and
conditions of insurance.
■ Legal advice abroad: Do you need initial legal advice regarding a legal issue of road traffic?
ADAC will arrange for the services of a lawyer. The club may pay a contribution up to 52.– F.
2. Acquisition or conversion of the ADACPlusMembership?
You can apply for the ADACPlusMembership any time. The subscription year for the ADACPlusMembership
starts in the month of application or acceptance of the offer. The commencement and the
end of the entitlement as well as the payment of the ADACPlusMembership are subject to the
conditions of “ADAC Breakdown and Accident Assistance for ADAC members” (see part A).
Switching back to an ADAC Membership (without ADACPlusMembership benefits) is always possible
at the next due date and has to be applied for no later than one month before the next due date of
the membership fee.
After an incident, requiring Schutzbrief benefits or other benefits from the ADACPlusMembership,
you or the club can change back to the basic membership. You or the club (whichever is applicable)
have to be informed in writing about this change no later than one month following the incident. The
change will become effective one month after the notification has been received. The balance from
the ADAC membership with Plus benefits will be refunded to you on a pro-rata basis on request, or
credited to your membership account.
If the membership fee is increased, you can – within a period of one month following receipt of our
communication – convert the ADACPlusMembership to an ADAC Membership without Plus cover
from the day the fee increase takes effect.
You will receive the detailed terms and conditions of the ADACPlusMembership with your ADAC-
PlusService Booklet.
C. ADAC-En-routeCover within the ADAC-PartnerPlusPackage
(as of 1 September 2004)
1. Which benefits are you entitled to?
In addition to the services and benefits of the ADAC breakdown and accident assistance (part A)
and the ADACPlusMembership (part B) within the framework of the ADACEn-routeCover you are
entitled to the services and benefits under
■ the accident emergency assistance (Unfall-Sofortleistung)
(insurer: ADAC-Schutzbrief Vers.-AG, 81362 München)
■ the legal expenses resulting from claims under tourist travel contracts
(e.g. tour operator, hotel contracts)
(Reise-Vertrags-Rechtsschutz)
(insurer: ADAC-Rechtsschutz Vers.-AG, 81364 München) and
■ the international liability insurance (Auslandsreise-Haftpflicht)
(insurer: ARISA Assurances S.A., B.P. 3051, L-1030 Luxembourg).
For the ADAC-En-routeCover your club signed group insurance contracts. The group insurance conditions
of the above-mentioned companies apply. The group insurance policies are separate, legally
independent insurance contracts. Claims for services and benefits under the ADAC-En-routeCover
can only be raised against the insurer in charge. You can place your claims directly with the insurer
in charge.
2. Acquisition of the ADAC-En-routeCover?
You can apply for the ADAC-En-routeCover together with the ADAC-PartnerPlusPackage, if you have
a valid ADACPlusMembership and your partner has a valid ADAC-PartnerMembership. The new
ADAC-En-routeCover can only be acquired in combination with the ADAC-PartnerPlusPackage.
The subscription year for the ADAC-En-routeCover starts in the month of application together with
the ADAC-PartnerPlusPackage or acceptance of a club offer. The commencement and the end
of the entitlement as well as the payment of the ADAC-En-routeCover are subject to the
conditions of “ADAC Breakdown and Accident Assistance for ADAC members” (see part A).
3. When does your ADAC-En-routeCover end?
The ADAC-En-routeCover can only be terminated together with the ADAC-PartnerPlusPackage.
a) Switching back to an ADACPlusMembership (without ADAC-En-routeCover) is always possible at
the next due date and has to be applied for no later than one month before the next due date of
the membership fee. Please note that cancellation of your ADAC-En-routeCover automatically
terminates your ADAC-PartnerPlusPackage.
b) After an incident, requiring ADAC-En-routeCover benefits, you or the club can terminate the
ADAC-En-routeCover, changing to a ADACPlusMembership without the ADAC-PartnerPlus-
Package (and without the ADAC-En-routeCover). You or the club (whichever is applicable) have to
be informed in writing about this change no later than one month following the incident. The
change will become effective one month after the notification has been received. The balance
from the ADAC-En-routeCover will be refunded to you on a pro-rata basis on request, or credited
to your membership account.
c) If the fee is increased, you can – within a period of one month following receipt of our communication
– terminate the ADAC-En-routeCover together with the ADAC-PartnerPlusPackage from
the day the fee increase takes effect.
d) The ADAC-En-routeCover ends automatically in the event of any other termination of the ADAC-
PartnerPlusPackage; e.g.:
■ If your ADACPlusMembership is changed to a membership without Plus cover, the ADAC-EnrouteCover
together with the ADAC-PartnerPlusPackage is terminated.
■ If the ADAC-PartnerMemberhip is terminated, the ADAC-En-routeCover is terminated.
You will receive the detailed terms and conditions of the ADAC-En-routeCover under the ADAC-
PartnerPlusPackage with your ADAC-PartnerPlusService Booklet.
D. ADAC accident insurance and ARISA liability insurance
for ADAC Youth Members
(as of 1 January 2003)
In addition to the ADAC breakdown and accident insurance you as an ADAC Youth Member from the
15th to the 18th birthday are entitled to services of the ADAC accident insurance and the ARISA
private liability insurance (private liability insurance with an insured sum of 350,000.– F; accident
insurance with an insured sum of 8,000.– F from permanent invalidity of 50%). Your club signed
group insurance contracts in your favour with ADAC-Schutzbrief Versicherungs-AG, 81362 München
and ARISA ASSURANCES S.A., B.P. 3051, L-1030 Luxembourg, where you can claim your service
directly. The individual insurance policies are separate, legally independent insurance contracts.
Claims can only be raised against the insurer in charge. There is no joint and several liability of the
insurers for risks covered by another insurer. The group insurance conditions of ADAC-Versicherungs-AG
for the ADAC accident insurance and the group insurance conditions of the ARISA private
liability insurance apply. You will receive the detailed insurance conditions of ADAC accident
insurance and ARISA private liability insurance, the other consumer information and the insurance
policies with your Youth Membership documents.
Data privacy agreement clause
I agree that ADAC e.V., its affiliated subsidiaries and the regional clubs of ADAC within the scope
required store general membership and service data resulting from the application documents
or contract execution (membership fees, insurance cases, risk / contract modifications) in joint
databases and transmit these data to co-operation partners of ADAC where absolutely required for
the provision of contractually agreed services (e.g. ADAC recovery agents).
Health data may exclusively be transmitted to the services in charge of assistance (assistance
centres, air rescue, ambulance service).
I further agree – with no effect on the contract and subject to revocation any time – that my general
membership and service data are used for advice and support with respect to all services of ADAC
e.V. and its subsidiaries. This also applies to all e-mail addresses supplied.
ADAC e.V., 81360 München, www.adac.de
Phone +49 89 76 76 66 32
Fax +49 89 76 76 63 46
President: Peter Meyer
Registered at Amtsgericht München, No. 304