Personal details:


First and all Middle Names

Surname / Lastname

Your Telephone number

Your E-Mail

Street & House Number (in Germany)

Postal Code (in Germany)

City (in Germany)

Date of Birth

Your Nationality

If Other, please enter your Nationality


Date 1st Driving license issued

Driving Lic issued in what country?

Your Car/Motorbike/Motorhome:



Month and year of first registration

Purchase Date

Type of chassis

Fuel type

Cubic Capacity / Engine size

Brake Horse Power (BHP)

Gearbox transmission

Value of the vehicle in Euros

Is the car financed?

Annual Mileage in kilometres

Where is car kept at night?

If Campervan/Motorhome: Is the roof made of steel, aluminium, fibre-reinforced plastic or does it have any special hailstone-protection?

Insurance details:

Type of insurance cover

Start Date of Policy

Any Accidents/Claims within 5 Years?

Number of Years No Claims Bonus Available for this Policy

Where is your no-claims-certificate coming from? (Country of your last car insurance)

Do you need an Additional Driver on the Policy?

Name (Additional Driver)

Date of Birth (Additional Driver)

Relationship to Insured (Additional Driver)

Additional driver's nationality

Date 1st Driving license issued (Additional Driver)

Additional Information:

Do you wish to have Breakdown Assistance?

Do you wish to have Traffic Legal Insurance?