O. Girke - International Insurance and Travel Service
IATA
Motor Insurance Call-Centre

Personal Quote

Client Details
   
Rank & Full Name
Unit Adress
Civilian City & Postcode
E-Mail adress
Tel.-No.
Date of birth
Is client?

Vehicle Details
   
Exact make
Exact Model
Date of first registration
Date 1st reg. in client's name
BHP/PS/KW
CC
Diesel Yes No
Cabriolet Yes No
Hatchback/Saloon/Estate

Drivers
     
Name Date of Birth License details/Date of issue
 
   
     
   

Previous Car Insurance
   
Company
Policy-No.
No claims discount entitlement
Claims during last 12 months
House/Flat-owner in Germany? Yes No
if yes, which:
   
Existing or previous AXA Germany customer Yes No
Policy-No.  
  change of vehicle
second car quote
   
Average annual mileage in km  
Garage/Carport/Street/Camp  
Further comments  

Quote based on details given above
       
NCB-protection required?
(only for customers with entitlement of 5 years and more) 
Third Party PLUS
Fire & Theft 150,- EURO excess
OR PLUS
Fire&Theft nil excess		 OR PLUS
Fully Comp.300,-/150,- EURO
OR PLUS
Fully Comp. 150,-EURO/ NIL		 Traffic Legal Aid Insurance