Personal Details

First name*

Middle name

Last name*

Email*

Phone*

Date of birth*

Gender*

Country of citizenship*

Job title*

Employer*

Fiscal code*

Street*

City*

State/ Province / Region*

Postal code*

Country*

Vehicle Details

Make*

Model*

Version*

Year of make*

Month of make*

Engine size*

Fuel type*

License plate number

Estimated value*

Are you the owner of the vehicle?*

Have you been insured in Italy before?*

License plate number (if already insured in Italy)

Type of coverage*

Third Party Liability / RCA
Third Party Liability, Fire & Theft / RCA, Incendio & Furto
Third Party Liability, Fire & Theft, Vandalism, Natural Events, Glass (without collision) / RCA, Incendio & Furto, Atti Vandalici, Eventi Naturali, Cristalli (Senza Casco)
Full Comprehensive (Physical Damage including Collision) / RCA & Max Casco

Additional coverage options

Additional comments