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 Bonus / Penalty coefficient

Date of car license (If obtained):

Auto Bonus / Penalty coefficient

Canceled during the last 36 months?

Reason for termination?

Number of claims over the last 36 months:

Date sinistre

Type sinistreBroken glassTotal/partial fireResponsible material with third partiesMatériel responsable sans tiersResponsible material with third partiesResponsible material with third partiesNon-responsible bodyResponsible body

Date sinistre 2

Type sinistre 2Broken glassTotal/partial fireResponsible material with third partiesMatériel responsable sans tiersResponsible material with third partiesResponsible material with third partiesNon-responsible bodyResponsible body

Date sinistre 3

Type sinistre 3Broken glassTotal/partial fireResponsible material with third partiesMatériel responsable sans tiersResponsible material with third partiesResponsible material with third partiesNon-responsible bodyResponsible body

License already suspended?

Reason for suspension?

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

Desired formula