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Motorhome & Camper Van insurance in France

For a motorhome and camper van insurance quotation, please fill in the form below, making sure to complete all fields.


1. PROPOSER


Date of birth:




Mobile:


Town:


Occupation:


Date of 1st driving license:




Fax:


Address (in France):


Postcode:


Marital Status:

 

2. INSURANCE HISTORY
No of years insured in France:
...in the UK:
...in another country:

Have you been insured for the past 3 years? Yes   No

How many months interruption of insurance during the past 12 months?

 
Name of your previous / current insurance company:  
Policy No.:  
Date of cancellation: (dd/mm/yy)  
...or next renewal date:  

 

3. CLAIMS HISTORY IN THE PAST 5 YEARS
    (Please answer by '0' if none)
Number of RESPONSIBLE MATERIAL accidents:  
Date of each one:     
Number of RESPONSIBLE BODILY accidents:  
Date of each one:     
Number of PARKING accidents:  
Date of each one:     
Number of THEFTS:  
Date of each one:     
Number of FIRES:  
Date of each one:     
Number of GLASS BREAKAGE:  
Date of each one:     

 

4. DRIVERS
Main user - Surname & First name:  
Main user - Date of birth:   (dd/mm/yy)
Main user - Date of 1st driving license:   (dd/mm/yy)
Main user - Occupation:  
Spouse - Surname & First name:  
Spouse - Date of birth:   (dd/mm/yy)
Spouse - Date of 1st driving license:   (dd/mm/yy)
Spouse - Occupation:  
1st Child < 26 years old - Surname & First name:  
1st Child - Date of birth:   (dd/mm/yy)
1st Child - Date of 1st driving license:   (dd/mm/yy)
1st Child - Occupation:  
2nd Child < 26 years old - Surname & First name:  
2nd Child - Date of birth:   (dd/mm/yy)
2nd Child - Date of 1st driving license:   (dd/mm/yy)
2nd Child - Occupation:  
HAS ONE OF THE DRIVER'S LICENCES BEEN WITHDRAWN FOR MORE THAN 1 MONTH IN THE LAST 3 YEARS?    Yes   No
If yes, give details:  

 

5. VEHICLE DETAILS
  (Please look at your 'Carte Grise' / registration document)
Make:  
 
Body:  
No of doors:  
Diesel?    Yes   No
Turbo Diesel?    Yes   No
Petrol?    Yes   No
Automatic gearbox?    Yes   No
Horse power in CC:  
Puissance in CV (french):  
 
Date of 1st registration:   (dd/mm/yy)
Registration / Immatriculation No:  
Value as NEW in Euros:  
Estimated current value in Euros:  
Do you have a locked garage for it?    Yes   No
Is the car equipped with a certified burglar alarm or immobiliser system?    Yes   No
 
 
 
 

 

6. COVER REQUIRED
Comprehensive    Yes   No
Third Party + Fire & Theft + Glass breakage    Yes   No
Third Part only    Yes   No
DATE OF INSURANCE REQUIRED COMMENCING ON:   (dd/mm/yy)
Receive relevant information from third parties?
Yes   No

 

 

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