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Car insurance questionnaire

Your car insurance study, in five minutes.

Answer what applies to you: only your contact details are required. The more precise you are, the more accurate our proposal. Documents can reach us later.

Fill it in online (5 min) Download the PDF
Car insurance questionnaire, ASSUDIRE
6 stepsabout 5 minutes
Step 1 of 6 · Youabout 5 min left

* Only your contact details are required

1. You
You1 / 6

The policyholder.

Why? Your contact details are used to call you back and to draw up the study in your name.

Title
Marital status
Status
2. Drivers
Drivers2 / 6

The main driver and, if any, the secondary driver.

Why? Age, years of licence and each driver's record weigh the most in the price.

The main driver is
Licence issued in
Accompanied driving scheme
Licence suspension or cancellation, drink or drug driving (last 5 years)
Relationship to the policyholder
Use of the vehicle by this driver
3. Your insurance history
Your insurance history3 / 6

Your claims record (relevé d'informations) will confirm these details; without it, we prepare a first estimate.

Why? Your bonus-malus and recent claims decide which insurers can accept you.

Currently insured
€ / year
Claims in the last 36 months (including non-fault)
DateType (accident, theft, glass…)Liability (0 / 50 / 100 %)
Cancelled by an insurer in the last 36 months
4. The vehicle
The vehicle4 / 6

Why? The model, its use and where it is parked set the risk, hence the premium.

CV
Gearbox
Fuel
km
€
Purchase
Use
Registered keeper
Overnight parking
Vehicle registered in France
Anti-theft device
Trailer or caravan over 750 kg
5. Your needs
Your needs5 / 6

Why? So we compare like with like and you never pay for cover you do not need.

Cover wanted
Cover and services
Excess
Payment
Start date wanted
€ / year
6. Documents to attach
Documents to attach6 / 6

Photos or scans are fine.

Why? With these documents, the quote becomes a firm proposal.

Your current insurer issues the claims record on request, within two weeks. Without it we prepare a first estimate; the final premium depends on it.

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