Motor insurance proposal form

PRINTABLE VERSION (.PDF)
Τhe files marked with an * are optional for the submission of the from.

1 Details of the proposer / owner

2 Details of the driver and driving licence

3 Details of the vehicle

4Cover required

Third party liability onlyFire, theft and supplementary perilsFull comprehensiveAccidental breakage of glassesMotor assistance (full)Legal protection

5Special discounts

6Previous insurance

7 Period of insurance – Premium

Notes
I hereby declare that the above statements and particulars are true and that I have not suppressed or misstated any material facts and Iagree that this proposal form and any supplementary information sheet(s) attached hereto shall be the basis of any relevant insurance policy issued.
Submiting the form does not bind the proposer nor the insurer to proceed with this insurance coverage.