QUOTE APPLICATION FORM: Vehicle

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Do you give Finkor consent to share your personal information, in order to prepare insurance quotations for you? *

Surname, Brith names & Title: *

Financed 2:

ID nr *

Celphone Number *

Email *

Occupation *

Pensioner *

Marital Status *

Total years of car insurance and with whom? *

With whom are you currently insured with? *

Have you ever been the regular driver on a policy?

If yes, for how long and with whom? *

Your current premium? *

Address *

Area Code: *

Did you experience any losses in the last 7 years? *

If so, please specify below:

1: Date

1: Section

1: Circumstance

1: Amount

2: Date

2: Section

2: Circumstance

2: Amount

3: Date

3: Section

3: Circumstance

3: Amount

Vehicle 1: Year Model

eg 2008

Vehicle 1: Make

eg BMW, Toyota

Vehicle 1: Model

eg. 318 A/T, ens

Vehicle 1: Registered owner Name, Surname and ID

Vehicle 1: Value of vehicle

Vehicle 1: Color of vehicle and is the vehicle metallic?

Vehicle 1: Is the vehicle financed

Vehicle 1: If YES, where is it Financed

Vehicle 1: Funding House, Contract numbers and Expiration Date:

Vehicle 1: Address of Overnight Parking

Vehicle 1: Overnight, e.g. locked gates, garage

Vehicle 1: Address of Day parking

Vehicle 1: Day, e.g. locked gates with security guard

Vehicle 1: Car hire option

LOSS
REPAIR
NONE

Vehicle 1: If yes, please confirm the amount of days.

Vehicle 1: Regular driver Name, Surname and ID

Vehicle 1: Date of first issue of license card:

Vehicle 1: Class of use

Private
Business

Vehicle 1: What security is in vehicle?

Vehicle 1 : Extras on the vehicle: Description and replacement value of the extras:

Vehicle 1: Vin Number:

Vehicle 1: Engine:

Vehicle 1: Reg:

Vehicle 2: Year Model

eg 2008

Vehicle 2: Make

eg BMW, Toyota

Vehicle 2: Model

eg. 318 A/T, ens

Vehicle 2: Registered owner Name, Surname and ID

Vehicle 2: Value of vehicle

Vehicle 2: Color of vehicle and is the vehicle metallic?

Vehicle 2: Is the vehicle financed

Vehicle 2: If YES, where is it Financed

Vehicle 2: Funding House, Contract numbers and Expiration Date:

Vehicle 2: Address of Overnight Parking

Vehicle 2: Overnight, e.g. locked gates, garage

Vehicle 2: Address of Day Parking

Vehicle 2: Day, e.g. locked gates with security guard

Vehicle 2: Car hire option

LOSS
REPAIR
NONE

Vehicle 2: If yes, please confirm the amount of days.

Vehicle 2: Regular driver Name, Surname and ID

Vehicle 2: Date of first issue of license card:

Vehicle 2: Class of use

Private
Business

Vehicle 2: What security is in vehicle?

Vehicle 2 : Extras on the vehicle: Description and replacement value of the extras:

Vehicle 2: Vin Number:

Vehicle 2: Engine:

Vehicle 2: Reg:

Vehicle 3: Year Model

eg 2008

Vehicle 3: Make

eg BMW, Toyota

Vehicle 3: Model

eg. 318 A/T, ens

Vehicle 3: Registered owner Name, Surname and ID

Vehicle 3: Value of vehicle

Vehicle 3: Color of vehicle and is the vehicle metallic?

Vehicle 3: Is the vehicle financed

Vehicle 3: If YES, where is it Financed

Vehicle 3: Funding House, Contract numbers and Expiration Date:

Vehicle 3: Address of Overnight Parking

Vehicle 3: Overnight, e.g. locked gates, garage

Vehicle 3: Address of Day Parking

Vehicle 3: Day, e.g. locked gates with security guard

Vehicle 3: Car hire option

LOSS
REPAIR
NONE

Vehicle 3: If yes, please confirm the amount of days.

Vehicle 3: Regular driver Name, Surname and ID

Vehicle 3: Date of first issue of license card:

Vehicle 3: Class of use

Private
Business

Vehicle 3: What security is in vehicle?

Vehicle 3 : Extras on the vehicle: Description and replacement value of the extras:

Vehicle 3: Vin Number:

Vehicle 3: Engine

Vehicle 3: Reg

Vehicle 4: Year Model

eg 2008

Vehicle 4: Make

eg BMW, Toyota

Vehicle 4: Model

eg. 318 A/T, ens

Vehicle 4: Registered owner Name, Surname and ID

Vehicle 4: Value of vehicle

Vehicle 4: Color of vehicle and is the vehicle metallic?

Vehicle 4: Is the vehicle financed

Vehicle 4: If YES, where is it Financed

Vehicle 4: Funding House, Contract numbers and Expiration Date:

Vehicle 4: Address of Overnight Parking

Vehicle 4: Overnight, e.g. locked gates, garage

Vehicle 4: Address of Day Parking

Vehicle 4: Day, e.g. locked gates with security guard

Vehicle 4: Car hire option

LOSS
REPAIR
NONE

Vehicle 4: If yes, please confirm the amount of days.

Vehicle 4: Regular driver Name, Surname and ID

Vehicle 4: Date of first issue of license card:

Vehicle 4: Class of use

Private
Business

Vehicle 4: What security is in vehicle?

Vehicle 4 : Extras on the vehicle: Description and replacement value of the extras:

Vehicle 4: Vin Number:

Vehicle 4: Engine:

Vehicle 4: Reg:

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