Young Driver - Motor Insurance Quotation Form

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 the highest standard of insurance cover on today's BFG/ NATO market.

All our Young Driver motor insurance policies come with European Roadside- Assistance, business cover, variable excesses, flexible payment methods, payment- freeze but cover guarantee period (if on Operational Tour), and most importantly an easy stress-free claim procedure with swift settlement (hire car also included).

Worried about when you leave Germany? No need! We have no kind of cancellation fee, your refund will be calculated by the day- not the month, your No Claims Discount certificate will be in English and if necessary we can even confirm your entitlement to your new company over the phone.

Unsure of whether you may be able to afford the car 'of your dreams'? Find out using our Loan Calculator.

Personal Details
Salutation: Mr. Mrs. Miss. Ms. Dr.
BFPO/ Unit address:	Postal address:* (n/a if same as unit)
Telephone number:*
Fax number:*
Email address:
Date of Birth:	. .
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
Vehicle Details
Make of vehicle:
Model:
Value:	£ €
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 Open Driver
Type of insurance cover: [ ? ]	--- Please select --- Third Party / Min. cover Third Party, Fire & Theft Fully Comprehensive
Excess(es) in € [ ? ]	--- 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/ third vehicle*
I wish to change my vehicle*
*optional
Remarks/ Additional information
Is this form understandable and easy to complete?	Yes Yes, but still room for improvement NO!!!
You need other than motor insurance? Please be so kind to contact one of our offices. Thank you!