Calculate Your contribution – Communication OC/AC Insurance

Basic information about a car

Production year:

Mark:

Model:

Engine capacity:

Fuel Type:

Model version:

Color:

The vehicle ever registered abroad Poland:
Yes - steering wheel on the left sideYes - steering wheel on the right sideNo

Year of vehicle purchase:

How many kilometers per year you drive this car ?:

Current course (km):

The planned course of the next year (km):

Purpose of Use:
PrivateOther

The planned period of time of using the vehicle abroad:
1 month or lessLonger

Will the vehicle be driven by young people (up to 25 years) or inexperienced (driving license for less than 2 years)?
YesNo

Whether the vehicle is in credit or leasing?
NoCreditLeasing

Type of vehicle user:
An individualOne-man businessFirmFirm with assigned user

The number of anti-theft protections:

Year of obtaining first driving license:

Marital status:

Current profession:

Discount / increase for insurance record of the last concluded insurance OC policy:

BM Class

The number of claims of liability OC insurance in the last 12 months:
0123 and more

Discount / increase for insurance record of the last concluded insurance AC policy:

BM Class

The number of claims of liability AC insurance in the last 12 months:
0123 and more

Number of owners
012

Vehicle parking place:

Postal code of vehicle parking place:

Name and Surname:

PESEL:

E-mail:

Address:

Additional information/questions: