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Motor Insurance Quotation - Ex-Pat

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Taking out motor insurance with Culpeck Insurance Broker means that you can be sure to gain cover via a long- established, very professional English/ German speaking company with one of the highest standards of insurance cover on today's German market, tailored for Ex-Forces personnel.

All our motor insurance policies come with roadside- assistance, business cover, variable excesses, flexible payment methods, and most importantly an easy stress-free claim procedure with swift settlement (hire car also included).

To cut a long story short - want the best, ignore the rest.

Personal Details
Salutation: Mr. Mrs. Miss. Ms. Dr.
Date of Birth:	/ /
Street Name
Post Code
Town
Telephone number*
Fax number*
Email address
Married/ engaged or do you have a life- partner	Yes No
No Claims Bonus entitlement	--- Please select --- License less than 3 yrs License more than 3 yrs 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years 26 years 27 years 28 years 29 years 30 years 31 years 32 years 33 years 34 years 35 years
Vehicle Details
Make of vehicle
Model
Type of chassis	--- Please select --- 2 dr convertible 2 dr coupe 3 dr hatchback 4 dr saloon 5 dr hatchback Estate Jeep/ 4WD Minibus (7 seater) Other
Cubic Capacity	Diesel
kW*/ bhp*	/
First year of registration	--- Please select --- brand new 2010 2009 2008 2007 2006 2005 2004 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 before 1985
Cover Required
Driver(s)	--- Please select --- Insured only Insured & Spouse Youngest Driver under 25 Youngest Driver over 25
Km per year	--- Please select --- 6000 9000 12000 15000 20000 25000 30000 30k+
Type of insurance cover [ ? ]	--- Please select --- Third Party / Min. cover Third Party, Fire & Theft Fully Comprehensive
Excess(es) in Euro [ ? ]	--- Please select ---
Traffic Legal Insurance* [ ? ]	yes no
Personal Accident Insurance* [ ? ]	yes no
I am not a client of Culpeck Insurance Broker...
...but I am seeking new insurance*
...as my policy is due for renewal*
For Culpeck clients only
My policy is due for renewal/ I would like Culpeck to check my premium*
I have purchased a second vehicle*
I wish to change my vehicle*
*optional
Remarks/ Additional information
You need other than motor insurance? Please be so kind to contact one of our offices. Thank you!