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License plate

Type of license plate

black license plate

Seasonal license plate

historic license plate

07 license plate

Seasonal license plate – valid from Relevant only for seasonal license plates.

Seasonal license plate – valid until

Type of vehicle

PKW

Motorcycle

Tractor

LKW

andere

Type of vehicle (other) Fill in only if "other" was selected as vehicle type

Vehicle Manufacturer and Model

HSN

TSN

Vehicle Manufacturer and Model (Plain Text)

Is it an electric or hybrid vehicle?

yes

Are the vehicle's batteries rented?

yes

Relevant only for electric or hybrid vehicles.

Remarks for more precise classification (maximum speed, seats, etc.)

Estimated Market Value (€)

Is the Vehicle Leased / Financed by Credit?

geleast

kreditfinanziert

Loan financing term (months) Relevant only for credit-financed vehicles.

Year of construction

Vehicle's first registration

Registration in the name of the policyholder?

yes

Zustandsnote des Fahrzeugs (1 = sehr gut; 6 = schlecht)

Estimated annual mileage (km)

Current Odometer Reading (km)

Are special equipment installed in the vehicle?

yes

Special equipment – description and values

Regular and predominant parking location

(Underground) Garage

andere

Parking space (other)

Is the vehicle used for everyday driving?

yes

Do you use additional comparable vehicles?

yes

Do you have driving experience with comparable vehicles?

yes

Driving experience with comparable vehicles since

Are there any special or unusual risk situations?

yes

Special or Unusual Risk Situations – Explanation

Vehicle owner (as per vehicle registration) – name

Vehicle Owner – Gender

weiblich

male

Vehicle Owner – Date of Birth

Is the Policyholder also the Owner?

yes

Policyholder (different from owner) – Name

Policyholder (different) – Gender

weiblich

male

Policyholder (different) – Date of Birth

Is Vehicle User also the Policyholder?

yes

Vehicle User (different from Policyholder) – Name

Vehicle User (different) – Date of Birth

Additional vehicle users – names and birthdates

Professional status of the policyholder

Professional status (other)

Industry of the policyholder

Negative entries in business credit files (Creditreform, Infoscore, SCHUFA) present?

yes

Negative entries – more detailed information

Is it a pure exhibition piece (no driving)?

yes

Are only (classic car) events attended with the vehicle?

yes

Usage of the vehicle

exclusively private

predominantly private

exclusively commercial

predominantly commercial

Are trips made outside Germany?

yes

Trips outside Germany – duration and countries

Is the vehicle driven on race tracks (except driver safety training)?

yes

Race track usage – detailed information

Die Angaben zum Alltagsfahrzeug entfallen, sofern der Versicherungsschein des Alltagsfahrzeugs als Anlage beigefügt wird.

License plate of the everyday vehicle

Manufacturer/Model of the Everyday Vehicle

Manufacturer Number (Everyday Vehicle)

Type Key Number (Everyday Vehicle)

Insurance Certificate Number of Everyday Vehicle

Insurance Company of Everyday Vehicle

Previous insurance / previous damages

vorhanden

not available

Previous insurance – Company

Previous Insurance – Contract Number

Termination by

Policyholder

Insurer

Liability – no-claims discount (NCD) class

Liability – NCD valid since year

Partial coverage – deductible (€)

Comprehensive – Deductible (€)

Comprehensive – No-claims class (SF)

Comprehensive – SF valid since year

Previous insurance – All-risk coverage

All-Risk Coverage Available

Have there been any prior damages in the last 5 years?

yes

Previous damages in the last 5 years – detailed information

Annual Premium per Current Contribution Statement (€)

Is a seasonal license plate desired?

yes

Seasonal license plate – desired duration

Desired Scope of Future Insurance Coverage

Liability

Partial coverage

Comprehensive Insurance

All-Risk Coverage

Desired deductible for partial coverage (€)

Desired deductible for comprehensive coverage (€)

Desired insurance value

Market value

Replacement value

Restoration value

Requested payment method

by invoice

by direct debit

Requested payment frequency

1/1 annually

1/2 annually

1/4 annually

1/12 annually

Is additional insurance coverage desired?

yes

Additional desired insurance coverage

Driver protection

Protection letter

Should accumulators, charging cables etc. be co-insured? (for electric or hybrid vehicles)

yes

Systems

Copy of registration certificate part I

Current Photos (Close-up of Exterior, Interior, Engine Compartment, and Trunk)

Valuation report (not older than 2 years)

Purchase invoice

Insurance Certificate of Everyday Vehicle

Other notes, remarks

Bei den Fragen handelt es sich um Fragen über gefahrerhebliche Umstände. Unvollständige und unrichtige Angaben zu den gefahrerheblichen Umständen berechtigen den Versicherer, im Falle der vorsätzlichen oder grob fahrlässigen Verletzung der Anzeigepflicht, vom Versicherungsvertrag zurückzutreten. Wird die Anzeigepflicht vorsätzlich oder grob fahrlässig verletzt, hat der Versicherer das Recht, den Vertrag innerhalb eines Monats ab Kenntnis von der Anzeigepflichtverletzung unter Einhaltung einer Frist von einem Monat zu kündigen. Diese Daten werden ggf. zur weiteren Verarbeitung (z. B. Angebotserstellung, Schadenbearbeitung etc.), wie in der Einwilligungserklärung zur Datenverarbeitung beschrieben, an Versicherer und Dienstleister weitergeleitet.

Date – Customer

Customer's signature

Upload signature as image Signature required

PRIVATE - Risk assessment exotics