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Email *
Which insurance do you want? *
How much deductible amount do you want in the comprehensive insurance? *
payment method *
Car manufacturer brand (e.g. BMW) *
Car type (e.g. X3) *
fuel type *
Number of seats *
Date of first registration *
MM
/
DD
/
YYYY
current bonus/penalty level
CO2 Emissions combined
List new price of the car (if known)
Price of the Extras (if known)
Gender
Date of birth
MM
/
DD
/
YYYY
Name
Surname
Adress (ZIP Code, City, Street, Number)
Is there an exemption from motor-related insurance tax?
Are you EU citizen?
Do you have any comments?
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