Motor vehicle insurance – request a quote

How would you like to be advised?

Preferred contact*

Quote by e-mailAdvice by phoneWritten quote by postPersonal consultation

Your contact details

Title*

Company

First name*

Last name*

Street / no.*

Postcode*

Town*

E-mail*

Phone*

Date of birth*

Insurers need your exact date of birth for the quote and application.

Nationality*

Residence permit*

Best day to reach me*

Best time to reach me*

Main driver

Last name, first name – main driver*

Vehicle details

You will find the vehicle master number and type approval number in the vehicle registration document (fields 18 and 24).

Vehicle type*

Make*

Model*

Body type*

Vehicle master number*

Type approval no.*

First registration – month*

First registration – year*

Mileage (km)

Vehicle leased / financed*

List price incl. accessories (approx.) in CHF*

Number plate

HP / cc / kg

Desired cover

Desired start of cover*

Currently insured with

Expiry date of current policy*I don’t have an existing policy yet

Personal details

Driving licence since*

Number of accidents in the last 5 years*

Number of licence withdrawals*

Your comments

Current policy (optional)

Do you have your current policy to hand? Upload it here (PDF or photo) so we can compare your cover precisely. No policy to hand or not insured yet? No problem – this field is optional.

Choose a file or take a photoPDF, JPG or PNG · up to 3 files

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