Please fill in the following application form, in order to enable us assist you in providing the best cover with the most appropraite price
 
COUNTRY
CITY
NAME
BIRTH DATE
OCCUPATION
TEL. NUMBER
TYPE OF VEHICLE
MAKE
YEAR OF MANUFACTURE
MARKET VALUE OF THE VECHILE
REQUESTED COVER
third party property damage
third party bodily injuries
third party + fire & theft
comprehensive
SERVICE
road assistance( provided free of charge)
extended warranty (for BMW vechicles)
replacement car
OTHER SERVICES