Request for a fully comprehensive motor insurance

Request for a fully comprehensive motor insurance

Take out your fully comprehensive car insurance quickly and easily today. We will be happy to provide you with an individual and non-binding offer. Please send us the completed application form. (* mandatory fields)

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Personal details *-please select-natural personlegal entity

Salutation *

• Mr.
• Ms. / Mrs.
• Diverse

Academic title

Please insert.

Name *

Street and house number *

Postal code / city *

Phone *

E-Mail *

Company *

Please enter your company name here.

Salutation *

• Mr.
• Ms. / Mrs.
• Diverse

Academic title

Please insert.

Policyholder *

Address line 1

Address line 2

Address line 3

Street and house number *

Postal code / city *

Phone *

E-Mail *

Manufacturer *

Model name *

Year of first registration *

Insurance value *

Insurance value in €

Vehicle condition *-please select-Original conditionStructurally modified (tuned)Structural change planned

Vehicle type *-please select-MotorcycleCarMotorhomeDelivery vans up to 3.5T gross vehicle weightTrucks over 3.5T gross vehicle weightTractor / agricultural tractorTractor unitTrailersOmnibusOthers

Annual mileage *-please select-up to 2500 kmup to 7500 kmup to 10000 kmup to 15000 kmmore than 15000 km

(in km)

Postal code / place of parking *

City / place of parking *

Type of parking space *-please select-Single / double garageUnderground / collective garageOther covered parking space (carport etc.)Open location (street etc.)

Utilization *-please select-Pure hobby use (without renting)Also everyday use (without rental)Chauffeur rentalSelf-drive rentalOther use without rental

Circle of drivers *-please select-PolicyholderPolicyholder + PartnerPolicyholder + partner + childrenOthers

Birthday of youngest driver *

Birthday of oldest driver *

Birthday of youngest driver *

Birthday of oldest driver *

Birthday of youngest driver *

Birthday of oldest driver *

License plate type *-please select-Normal license plateHistorical license plateSeasonal license plateHistoric seasonal license plateRed permanent license plate 07sGreen license plateWithout license plateE-license plate

Season from *

Season to *

Season from *

Season to *

Have more than 2 self-inflicted losses occurred in the past 3 years? *

• Yes
• No

Payment period *

• Annual
• Half-yearly
• Quarterly
• Monthly

Deductible *-please select-VK 0 € / TK 0 €VK 150 € / TK 0 €VK 300 € / TK 0 €VK 500 € / TK 0 €VK 1.000 € / TK 0 €VK 2.500 € / TK 0 €VK 5.000 € / TK 0 €VK 150 € / TK 150 €VK 300 € / TK 150 €VK 500 € / TK 150 €VK 1.000 € / TK 150 €VK 2.500 € / TK 150 €VK 5.000 € / TK 150 €VK 500 € / TK 500 €VK 1.000 € / TK 1.000 €VK 2.500 € / TK 2.500 €VK 5.000 € / TK 5.000 €VK 10.000 € / TK 10.000 €VK 25.000 € / TK 25.000 €VK 50.000 € / TK 50.000 €VK 100.000 € / TK 100.000 €

New registration or change of insurance *-please select-New registrationChange of insurance

Current mileage *

Please enter the current number of kilometers here.

Information on the proof of value *

• Purchase receipt / Purchase invoice
• Detailed expert opinion

Data protection *

• I hereby accept that my data will be used to process my request (raceinc.de).

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