Agency Allianz - Franck Haloche

Agency Allianz - Franck Haloche

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Call now for a FREE quote on: 033 (0)2 43 05 21 82

Car insuranceCar Insurance Form

To receive a quotation for Car Insurance, please fill in the following details and click SEND. We will then respond to you as soon as possible.

Because no two drivers are alike, and because driving practices evolve over time, our guarantees and packages have been designed to meet your unique needs. With Allianz, you are automatically covered for the following in our car insurance policy:

  • Public liability: Criminal defense and recourse after accident
  • Driver cover: 500,000€, 15% disability
  • Assistance (you must be at least 25km away from home, cover in France and Europe)
  • Natural disaster
  • Technological disaster
  • Terrorism attacks

Please note: We cannot offer you a short term/temporary insurance. We can only insure your English registered car if you are going to reregister your car in France in the following three months.

     
 MAIN DRIVER DETAILS
Full Name:*
 
Address in France  
Date of Birth: dd/mm/yyyy  
Date Driving Test Passed: dd/mm/yyyy  
Occupation:  
Email Address:*
 
Telephone:
 
Numbers of years insurance:  
Current insurance company:  
Number of years with current company:  
Current no claims bonus:  
Have you had any claims in the past 3 years?:
Type
Date
Responsibility (100%, 50%, 0%)?
 
     
 SECOND DRIVER DETAILS (PARTNER/SPOUSE)
Full Name:  
Address in France  
Date of Birth: dd/mm/yyyy  
Date Driving Test Passed: dd/mm/yyyy  
Occupation:  
Email Address:
 
Telephone:
 
Numbers of years insurance:  
Current insurance company:  
Number of years with current company:  
Current no claims bonus:  
Have you had any claims in the past 3 years?:
Type
Date
Responsibility (100%, 50%, 0%)?
 
     
 
     
Will you be lending your car to anyone else? Or do only you and your partner drive the car?  
Is France your main residency?  
Would you be interested in limited kilometers per year? This can be a cheaper option if you are not going to do over 10 000km per year.  
Do you use the car for private use only or also going to and from work?  
     
 CAR DETAILS
Make:  
Model and version:  
Fuel  
Capacity:  
Transmission:  
Number of Doors:  
Chassis Number(if known)  
Registration Number:  
Date of Registration: dd/mm/yyyy  
Date of Aquisition/Purchase: dd/mm/yyyy  
     
How did you purchase the car?  
Do you have a smartphone?  
Do you keep the car locked in a garage at night?  
     
 COVER
Type of cover:  
 
To complete our offer, you can also choose from several extra options listed below:
Pack mobilité classique (home start and replacement car for either 8, 15 or 30 days)  
Pack mobilité plus (home start and replacement car for 30 days)  
Pack reparation (reimbursement of breakdowns, remote diagnostics * conditions apply)  
Pack valeur plus (extra value in addition to experts evaluation: minimum of 3,000€ * conditions apply)  
Home start assistance  
Contents cover (up to 3000€)  
     
How did you hear about us?  
     
I am interested in receiving more information on your full insurance packages  
     
 
     
 
 
Please call us on 0033 (0)2 43 05 21 82 if you have any problem with this form
     
   
     

 

Agency Allianz - Franck Haloche

1 rue Louis Blériot
Parc d’activités des Sémondières
53500 ERNEE
France


© COPYRIGHT ALLIANZ FRANCK HALOCHE 2017

Tel: 0033 (0)2 43 05 21 82
EMail: 4005417@agents.allianz.fr