Vehicle owner
Surname
First name
Street, nr.
Zip code, city
Nationality, permit
Date of birth
Date of drivers license
Most frequent driver (If it is not the vehicle owner, please enter here all data according to the data of the vehicle owner above)
Telephone nr.
E-mail
Eventual insurance claims and drivers license withdrawals of the last 3 years. If it is applicable, please enter here the details.
Vehicle
Make, type
Date of first registration
Type certificate number (Format 01AB 543)
Identification nr. (Stamm nr.) (Format 111.222.333)
Catalog price in Fr.
Price of special equipment in Fr.
Financing
Usage
If you add a second vehicle to the same insurance policy, please enter here the details of the second vehicle according to the first vehicle above.
Mileage per year in km
Car is parked in a parking garage
Insurance details
Beginning of the contract
Desired maturities
License plate (If existing)
Desired insurance coverage
Deductibles
Prior insurance
Company, policies nr.
Please upload assisting documents here (e.g. previous insurance policies) -> it opens a new tab.