Name: Vanbreda Risk & Benefits
Price range: $

Name

First name

European official

Yes

No

Date of birth

Nationality

Country

Address

Street + no.

Locality

Postcode

Email address

Phone number

Are you the main driver?

Yes

No

Main driver

Name

First name

Occupation

Date of birth

Nationality

Country

Address

Street + no.

Locality

Postcode

Country

Email address

Phone number

Date of issue of driving licence

Transfer from another insurer?

Yes

No

Name of insurer

Policy number

Policy end date

Have you had any incidents incurring third-party liability (shared or full liability) in the last 5 years?

Yes

No

Date of incident + nature of incident

Number of years you have driven without any incident incurring third-party liability

How many kilometres do you drive per year?

Vehicle

Make

Model

Power in KW

Number of seats (apart from driver)

Vehicle purchased new?

Yes

No

Driver assistance system?

Yes

No

Date of first registration

Catalogue value in EUR (excluding VAT, without equipment)

Catalogue value (excluding VAT, with equipment)

Desired cover

Third-party liability

Required

Notes

Themes

Sectors

Related news

About us

Related news

Working at Vanbreda

Car insurance quotation - European officials

Main driver

Vehicle

Desired cover