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Car insurance : quote request

Full Name

Address in France

Phone number

Email

Car make, model and exact version

Registration number

Gear box *

Manual

Automatic

Engine Type *

Petrol

Diesel

Electric

Hybrid

Other

Date of manufacture * required

Date of purchase * required

How is / was the vehicle purchased ? *

Paid in full / cash purchased

Financed with a loan

Leased (leasing / long term rental)

Car usage *

Private use

Private and commute / business use

Business use including regular clients visit

How many kiloters per year ? *

Les than 4 000 km

less than 7 000 km

less than 9 000 km

more than 9 000 km

Vehicle usually parked in : *

Private garage

Private gated land

Underground car park

Open air car park / private land

Street

Main driver

Name

Date of birth * required

Date driving license obtained * required

Occupation

Second Driver

Name

Date of birth

Date driving license obtained

Occupation

No claims discount

I have a French no claims discount (eg. 0.50, 0.76 ...)

My no claims coefficient (coeff. de réduction majoration) is :

I don't have a French no claims discount.

I have

years no claims

50% or more

Less than 50% - please specify:

Representing :

%

Any claims in the past 3 years ? *

No

Yes

If yes, please describe briefly

Cover required *

Third party only

Third party fire and theft

Fully comprehensive

Comments

Envisaged start date

Thank you ! An advisor will contact you shortly.

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