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Motorhome and Camper Van insurance in France

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

1. PROPOSER
Last name: Date of birth: Telephone: Mobile: Town: Occupation: Date of 1st driving license:		First name: Your e-mail address: Fax: Address (in France): Postcode: Marital Status:

2. INSURANCE HISTORY

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

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

No Claims Bonus or Coefficient Bonus / Malus shown on your present / last insurance certificate

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HAS ONE OF THE DRIVER'S LICENCES BEEN WITHDRAWN FOR MORE THAN 1 MONTH IN THE LAST 3 YEARS?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:

Exact model:

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):

Serial No.:

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

Value of contents:

Value of awning:

Value of accessories & interior fittings:

Value of other accessories (if any):

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