Name:
Surname:
Town: Select Town Birkirkara Birzebbuga Bormla Dingli Fgura Floriana Ghajnsielem H' Attard Hal Balzan Hal Gharghur Hal Ghaxaq Hal Kirkop Hal Lija Hal Luqa Hal Qormi Hal Safi Hal Tarxien Haz-Zabbar Haz-Zebbug Il-Belt Valletta Il-Birgu Il-Fontana Il-Gudja Il-Gzira Il-Hamrun Il-Kalkara Il-Marsa Il-Mellieha Il-Mosta Il-Munxar Il-Qala Il-Qrendi In-Nadur In-Naxxar Ir-Rabat Ir-Rabat (Ghawdex) Is-Siggiewi Is-Swieqi Ix-Xaghra Ix-Xewkija Ix-Xghajra Iz-Zebbug (Ghawdex) Iz-Zejtun Iz-Zurrieq L-Gharb L-Ghasri L-Iklin L-Imdina L-Imgarr L-Imqabba L-Imsida L-Isla Marsaskala Marsaxlokk Paola Pembroke San Giljan San Gwann San Lawrenz San Pawl il-Bahar Santa Lucija Santa Venera Ta' Kercem Ta' Sannat Ta` Xbiex Tal-Pieta' Tas-Sliema
Post Code:
Date of Birth: DD/MM/YYYY
Gender: Select Male Female
ID Number: Select M G A H L
Telephone No:
Mobile No:
Email:
Registration No:
Make: Select car make Adly Aec Aeon Aleko Alfa Alfa Romeo Allen Amc Aprilia Ariel Aro Asia Motors Aston Astra Audi Austin Austin / Morris Austin / Rover Autobianchi A.J.S. Bajaj Balkan Bashan Bedford Bedford / Vauxhall Benelli Bmw Bmw (Standard) B. M. C. B.M.W. B.S.A. Caterpillar Changan Changhe Chevrolet Chrysler Citroen Coles Dacia Daelim Daelin Daewoo Daf Daihatsu Daimler Datsun Datsun / Nissan Datsun/Nissan Derbi Diesis Dinli Dodge Douglas Ducati Enfield Erf Faden Fehua Ferguson Massey Ferrari Fiat Fiesta Foden Ford Freight Freight Rover Fso Gilera Guy Big Halla Harley Davidson Hc Hexagon Hicom Hillman Holden Honda Hsun Hyosung Hyster Hyundai H.R.D. Imt Indian Innocenti Isuzu Italjet Iveco J C B Jago Jaguar Jcb Jeep Jimny Kasea Kato Kawasaki Kelisa Kia Kinko Quadbike Kmbota Kobello Komatsu Korando Krupp Ktm Kubora Kubota Kymco Lada Lambretta Lan Ying Lancia Land Rover Landcruiser Landrover Leyland Lf125St-5 Lifan Mahindra Malaguti Maruti Masai Maserati Massey Matchless Mazda Mbk Mercedes Mg Mgf Mini Mitsubishi Modenas Monza Morris Moto Guzzi Mtx Muz Mz Nichiyu Nissan Niva Norton O & K Opel Pajero Palio Pasbo Perkins Perodua Peugeot Piaggio Plan Tandberg Polaris Polonez Pontiac Porsche Premiere Proton Range Rover Rav Renault Renegade Reva Riley Rocsta Rolls Royce Rossi Rover Royale Saab Sachs Saddon Samsung Saxon Scammel Scania Schmidt Seat Seddon Sharpa Shenniu Sherpa Sierra Simca Singer Skoda Smart Ssangyong Standard Subaru Sudwind Sunbeam Suzuki Tadano Talbot Tata Tavria Tcm Tempo Tonda Toyota Triumph Tvr Universal Ursus Vauxhall Vespa Volkswagen Volvo Wartburg Willys Wolseley Xinling Yale Yamaha Yamar Yaris Yugo Zastava Zetor
Model:
Type of Car: Select vehicle type Beach Buggy Estate Glass Van Hatchback Jeep Saloon SUV Convertible Hard Top Convertible Soft Top
Year of Manufacture: Select year of manufacture 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 1892 1891 1890 1889 1888 1887 1886 1885 1884 1883 1882 1881 1880 1879 1878 1877 1876 1875 1874 1873 1872 1871 1870 1869
Year of Registration: Select year of registration 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 1892 1891 1890 1889 1888 1887 1886 1885 1884 1883 1882 1881 1880 1879 1878 1877 1876 1875 1874 1873 1872 1871 1870 1869
Engine Capacity: e.g. 1200
Is this vehicle equipped with an anti theft device: No Yes
Start of Cover: DD/MM/YYYY
End of Cover: DD/MM/YYYY
Level of Cover Required: Select policy type... Comprehensive Third Party Fire & Theft Third Party Only
Who will be driving the vehicle: Select drivers Insured Only Driving Insured and Spouse Two Named Drivers Any Driver over 25 Any Driver over 21 Named Drivers 21 to 24 and any driver ages 25 yrs and over
No Claim Discount: Select no claims... No Years 1 Year 2 Years 3 Years 4 Years 5 Years
Have you had any claims within the past 4 years? No Yes
Protected NCD:
Excess choice: Select excess... Standard Increase by €115 - A discount of 10% will apply Increase by €235 - A discount of 20% will apply
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Do you or anyone residing in the same household hold another active Motor Policy with us?
No Yes
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I have read and understood the Privacy policy
I agree to receiving information about other services and promotions offered by Citadel Insurance plc.
I do not agree to receiving information about other services and promotions offered by Citadel Insurance plc.