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Assurances Moto
The different
advantages
Immediate guarantee,
Contract and a provisional green card online.
Without history
CRM Bonus from 0.50 to 1.56 Penalty
Suspension or Cancellation for speeding and point failure
Quote
sheet
Name
*
First name
*
Date of birth
Phone
*
Postal code
*
City
*
Address
*
Your email address
*
Motorcycle driving license date:
Motorcycle driving license date:
Motorcycle Bonus / Penalty coefficient
Date of car license (If obtained):
Auto Bonus / Penalty coefficient
Canceled during the last 36 months?
No
Yes
Reason for termination?
Non-payment
Sinister
Blood alcohol level
Number of claims over the last 36 months:
Date sinistre
Type sinistre
Broken glass
Total/partial fire
Responsible material with third parties
Matériel responsable sans tiers
Responsible material with third parties
Responsible material with third parties
Non-responsible body
Responsible body
Date sinistre 2
Type sinistre 2
Broken glass
Total/partial fire
Responsible material with third parties
Matériel responsable sans tiers
Responsible material with third parties
Responsible material with third parties
Non-responsible body
Responsible body
Date sinistre 3
Type sinistre 3
Broken glass
Total/partial fire
Responsible material with third parties
Matériel responsable sans tiers
Responsible material with third parties
Responsible material with third parties
Non-responsible body
Responsible body
License already suspended?
No
Yes
Reason for suspension?
Blood alcohol level
Stunning
Sinister
Si suspension pour alcoolémie ou stupéfiant ? Indiquez svp Durée suspension
Taux d'alcool g/l dans le sang
Motorcycle brand
Motorcycle Model
Date of circulation ?
Date of purchase ?
Mine type (D.2 registration document):
CV power?
Fuel
Species
Diesel
Electrique
Desired formula
(F1): Civil Liability + Driver Guarantee + Breakdown Assistance
(F2): F1 + Theft + Fire + Glass breakage
(F3): F2 + Any Accident Damage
Enter additional information if necessary
I agree to receive a quote and to be called by an advisor from the MAM ASSUR company.
Send me a quote
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