Motor Insurance

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Your Quote
Quote Number
Premium Amount	€
Document Duty Amount	€
Policy Fee	€
Premium Total	€

Registration No

Make

Model

Type of Car

Year of Manufacture

Year of Registration

Engine Capacity

Engine No

Chassis No

System No

Seating Capacity

Colour

CO2 g/km

ADT Registration Year

Fuel Type

Is this vehicle equipped with an anti-theft device?

Level of Cover Required

Your estimated Value of the car incl. accessories

Who will be driving the vehicle?

Youngest driver's age

Roadside assist

No Claim Discount

Excess choice

Standard Excess Rates

Drivers Age	Loss of or damage to your car and liability to others	Liability to others
25 Years and Over	€55	Nil
21 Years and Over	€175	€115
18 Years of Over	€350	€235
When the claim is related to loss of or damage to the car due to fire and theft	€235	€235

*Common Excess will apply where your policy covers any authorised driver(s) aged between 18 and 20 years, irrespective of the age of the person who is driving the car when it is damaged – Not applicable on Commercial Vehicles

Voluntary Excess

(Not available on Motor cycle policies)

	Schedule Code
	VX50	VX100
Authorized Drivers aged 25 years & over:
Damage to your car:	€170	€290
Liability to others only:	NIL	NIL
Authorized Drivers aged between 21 & 24 years:
Damage to Your Car and liability to others:	€290	€410
Liability to others only:	€115	€115
Authorized Drivers aged between 18 & 20 years:
Damage to Your Car and liability to others:	€465	€235
Liability to others only:	€235	€235
This excess will apply where YOur Policy covers You and/or any Authorised Driver(s) aged between 18 and 20 years, irrespective of the age of the person who is driving YOur Car when it is damaged.
Fire and Theft: Loss of or damage to Your Car due to fire, lightning, self-ignition or explosion, theft, attempted theft, or fire following theft:	€235	€235

For all drivers, the amount of voluntary excess selected is to be added to the standard Excess in respect of own damage only.

Do you hold another active motor policy with us?

If so, state the vehicle registration number of that policy

Add Protection of No Claims Discount

Car Hire

Current insurer

Policy number or registration number of your vehicle at the current insurer

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