Klik - CAR INSURANCE

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Vehicle type:

Vehicle brand:

Vehicle model:

Cubic capacity:

ccm

Engine power:

Year of the vehicle production:

Gross vehicle weight:

System of protection:

Type of purchase:

Leasing company:

Duration of leasing contract:

Do you currently have casco insurance for your vehicle?

Yes No

Name:

Surname:

Personal identification number:

Identity card No.:

Address of residence:

Zip code and city:

Telephone No.:

E-mail for offers delivery:

I read terms and conditions and privacy policy and I agree with them

Thank you for using our service

We shall collect offers for the car insurance as soon as possible and we shall send them to the indicated e-mail address.

For the purpose of providing adequate information and in order to enable us to act as your insurance intermediary, please mark the following consents:

I read POWER OF ATTORNEY and I agree with it

I read INFORMATION FOR POLICYHOLDER and I agree with them