Name/company of Insured:
e-mail:*
Address:
Phone Number :

Registration number:
Make:
Model:
Type of vehicle:
Cubic Capacity of Engine:
Carrying Capacity:
Special purpose or function: e.g. taxi
Year of manufacture:
Type of fuel:
Number of doors:
Number of seats:

1. 2. 3. 4. Main cover: natural calamities; fire occurring during the operation of the vehicle; explosion; transport accidents (including accidents during parking); intentional third party actions; solid bodies or objects falling upon the vehicle; emergency situations with water supply systems, gas supply systems, heat supply systems or electrical installations. Extended cover: intentional third party actions; theft or robbery of a whole vehicle; damage resulting from robbery or attempted burglary;burglary of radio equipment(including also accidents during parking); solid bodies or objects falling upon the vehicle; emergency situations with water supply systems, gas supply systems, heat supply systems or electric installations; Special cover: the above-mentioned risks for abroad, as per agreement and explicitly stated in the insurance policy. Theft: theft and robbery of the entire vehicle.
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