Demand SFE-SAVE Quotation – International Fleet

    Membre syndicat

    Type of vehicle

    Type of registration

    VAT recovery

    Vehicle make-type

    Model

    Fuel

    Vehicle power

    Kw (code P2)

    HP – CV (code P1)

    1st registration date

    New vehicle

    Insured value

    New Vehicle

    2nd hand vehicle

    Miscellaneous

    1st owner

    Garage/carport

    Average annual mileage

    places nr(driver incl) :

    Technologies

    Automatic Emergency Braking :

    Lane Departure Warning System :

    Driver Drowsiness Detection :

    Emergency call:

    Adaptive cruise control :

    Automated parking system:

    Insurance Owner& Driver

    NAME

    SURNAME

    Date of Birth:

    Date of obtaining driving license

    Driver under 26 years old :

    Complete Address

    Street :

    N° :

    Box :

    Zip code :

    City :

    Claims historic based on 5 previous year

    Nbr of year without claims :

    Official NCB-no claims bonus:

    Claims historic :

    Type of insurance desired

    RC-3rd Party liability :

    PJ-DAS – Legal Protection :

    PC – Drive Protection :

    Mini-Omnium (Fire + nature force + Glass breakage + Theft)

    FULL Comprehensive (Mini omnium + Material damage) :

    rdv-en