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Form for : car (1)

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Brand
Model
Date of first registration
Ccm Engine - Make your choice - 0 - 1047 ccm 1048 - 1309 ccm 1310 - 2356 ccm 2357 - 2880 ccm 2881 - 4188 ccm 4189 - 5497 ccm More than 5497 ccm
Engine power (KW)
Original price with options and without discount
Driver’s age
Your current bonus on this vehicle - Make your choice - 11 (0%) 10 (0%) 9 (-10%) 8 (-15%) 7 (-20%) 6 (-25%) 5 (-30%) 4 (-35%) 3 (-40%) 2 (-45%) 1 (-50%) 0 (-52.5%) -1 (-55%) -2 (-55%) -3 (-55%) (over 55% discount)
Your coverage on this vehicle - Make your choice - Minimum: Civil Liability Legal Protection Intermediate: Minimum + Theft + Glass breakage + Fire Premium : Fullcasco
Have you taken out insurance for the driver

Form for : car (2)

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Brand
Model
Date of first registration
Ccm Engine - Make your choice - 0 - 1047 ccm 1048 - 1309 ccm 1310 - 2356 ccm 2357 - 2880 ccm 2881 - 4188 ccm 4189 - 5497 ccm More than 5497 ccm
Engine power (KW)
Original price with options and without discount
Driver’s age
Your current bonus on this vehicle - Make your choice - 11 (0%) 10 (0%) 9 (-10%) 8 (-15%) 7 (-20%) 6 (-25%) 5 (-30%) 4 (-35%) 3 (-40%) 2 (-45%) 1 (-50%) 0 (-52.5%) -1 (-55%) -2 (-55%) -3 (-55%) (over 55% discount)
Your coverage on this vehicle - Make your choice - Minimum: Civil Liability Legal Protection Intermediate: Minimum + Theft + Glass breakage + Fire Premium : Fullcasco
Have you taken out insurance for the driver

Form for : car (3)

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Brand
Model
Date of first registration
Ccm Engine - Make your choice - 0 - 1047 ccm 1048 - 1309 ccm 1310 - 2356 ccm 2357 - 2880 ccm 2881 - 4188 ccm 4189 - 5497 ccm More than 5497 ccm
Engine power (KW)
Original price with options and without discount
Driver’s age
Your current bonus on this vehicle - Make your choice - 11 (0%) 10 (0%) 9 (-10%) 8 (-15%) 7 (-20%) 6 (-25%) 5 (-30%) 4 (-35%) 3 (-40%) 2 (-45%) 1 (-50%) 0 (-52.5%) -1 (-55%) -2 (-55%) -3 (-55%) (over 55% discount)
Your coverage on this vehicle - Make your choice - Minimum: Civil Liability Legal Protection Intermediate: Minimum + Theft + Glass breakage + Fire Premium : Fullcasco
Have you taken out insurance for the driver

Form for : car (4)

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Brand
Model
Date of first registration
Ccm Engine - Make your choice - 0 - 1047 ccm 1048 - 1309 ccm 1310 - 2356 ccm 2357 - 2880 ccm 2881 - 4188 ccm 4189 - 5497 ccm More than 5497 ccm
Engine power (KW)
Original price with options and without discount
Driver’s age
Your current bonus on this vehicle - Make your choice - 11 (0%) 10 (0%) 9 (-10%) 8 (-15%) 7 (-20%) 6 (-25%) 5 (-30%) 4 (-35%) 3 (-40%) 2 (-45%) 1 (-50%) 0 (-52.5%) -1 (-55%) -2 (-55%) -3 (-55%) (over 55% discount)
Your coverage on this vehicle - Make your choice - Minimum: Civil Liability Legal Protection Intermediate: Minimum + Theft + Glass breakage + Fire Premium : Fullcasco
Have you taken out insurance for the driver

Form for : car (5)

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Brand
Model
Date of first registration
Ccm Engine - Make your choice - 0 - 1047 ccm 1048 - 1309 ccm 1310 - 2356 ccm 2357 - 2880 ccm 2881 - 4188 ccm 4189 - 5497 ccm More than 5497 ccm
Engine power (KW)
Original price with options and without discount
Driver’s age
Your current bonus on this vehicle - Make your choice - 11 (0%) 10 (0%) 9 (-10%) 8 (-15%) 7 (-20%) 6 (-25%) 5 (-30%) 4 (-35%) 3 (-40%) 2 (-45%) 1 (-50%) 0 (-52.5%) -1 (-55%) -2 (-55%) -3 (-55%) (over 55% discount)
Your coverage on this vehicle - Make your choice - Minimum: Civil Liability Legal Protection Intermediate: Minimum + Theft + Glass breakage + Fire Premium : Fullcasco
Have you taken out insurance for the driver