Private Car Comprehensive Proposal Form Step 1 of 4 25% Cover OptionsFrom* DD slash MM slash YYYY To* DD slash MM slash YYYY Type of plan*SelectPrincipalImperialAdditional CoverOption 1 Third Party liability for driving other private vehicles Option 2 Windscreen cover Sum insured Option 3 Cover for Trailer If yes, please give details Option 4 Cover for driving beyond the limits of a public road Option 5 Cover for Natural Perils Option 6 Replacement of the Motor Vehicle with a New one Option 7 Road Assistance and Accident Care Option 8 Loss of Use If yes, please give details for days and amount Option 9 No Claims Bonus Protection Option 10 Personal Accident of the Insured of 10,000 Euro Option 11 Personal Accident of the insured's spouse 10.000 EURO Option 12 Loss of personal effects (maximum amount 200 euro) Option 13 Strike,Lock-out,civil commotion Option 14 Loading/Unloading Proposer's DetailsName* Postal Address*Email* Telephone*Date of Birth* DD slash MM slash YYYY Occupational Status*SelectEmployedSelf EmployedHousehold DutiesUnemployedStudentClerical DutiesSupervisorOtherIdentity Card No* Present Insurer Are you entitled to No-Claims Discount? Yes If yes, the No. of Years12345 Second Driver DetailsName Date of Birth DD slash MM slash YYYY Occupational StatusSelectEmployedSelf EmployedHousehold DutiesUnemployedStudentClerical DutiesSupervisorOtherYear of Driving Test Passed Any person over 25 up to 70 and holder of driver's license for more than two years. Vehicle DetailsRegistration No* Vehicle Year* Vehicle Make* Vehicle Model* H.P. Number of passengers including driver* Date of Purchase* DD slash MM slash YYYY Value of Vehicle* Use of Vehicle Social,Domestic and pleasure and for the Insured's business For Data Protection Company Policy Click Here. * I have read the Data Protection Company Policy posted on this website I herewith provide Royal Insurance Company Ltd (and any successors and assignees thereof), my express and unconditional consent regarding the processing and creation of data records in electronic and physical form, of all my relevant personal data, that may include sensitive data which I have declared and submitted
