Please enable JavaScript in your browser to complete this form. - Step 1 of 3DETAILS OF THE VEHICLE OWNERName *Surname *Date Of Birth *Date of first issue of Driver's License *Country Of Origin *AfghanistanAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweProfessionAddressPostal CodeCity *FamagustaFamagustaLarnacaLimassolNicosiaPaphosPhoneEmail *How many years have you been driving without an accident (no claim bonus)? *7 years proven No Claim Bonus Discount7 years proven No Claim Bonus Discount6 years proven No Claim Bonus Discount5 years proven No Claim Bonus Discount4 years proven No Claim Bonus Discount3 years proven No Claim Bonus Discount2 years proven No Claim Bonus Discount1 years proven No Claim Bonus DiscountNo claims but no proof of No Claim BonusClaim €350 - €800 in the last three yearsClaim €801 - €4,000 in the last three yearsClaim €4,001 - €8,000 in the last three yearsClaim €8,001 - €12,000 in the last three yearsClaim €12,001 or more in the last three yearsOne or more convictions in the last three yearsHow many additional drivers will use the vehicle? *012345NextVEHICLE DETAILSType of coverage required *Security Against Third PartiesSecurity Against Third Party, Fire and TheftComprehensive InsuranceVehicle Value *Vehicle Use *PrivatePrivateCommercialDoes Your Vehicle Have License Plates? *YESNONo. Registration *Vehicle Manufacturer *AcuraAlfa RomeoAMCAston MartinAudiAvantiBentleyBMWBuickCadillacChevroletChryslerDaewooDaihatsuDatsunDodgeEagleFerrariFIATFordGeoGMCHondaHUMMERHyundaiInfinitiIsuzuJaguarJeepKiaLamborghiniLanciaLand RoverLexusLincolnLotusMaseratiMaybachMazdaMercedes-BenzMercuryMerkurMINIMitsubishiNissanOldsmobilePeugeotPlymouthPontiacPorscheRAMRenaultRolls-RoyceSaabSaturnScionSmartSterling<SubaruSuzukiToyotaTriumphVolkswagenVolvoYugoOtherManufacturer *Vehicle Model *Cubic (Cc) *< 1200cc1201 - 1400cc1401 - 1600cc1601 - 1800cc1801 - 2000cc2001 - 2500cc2501 - 3000cc> 3001ccNumber of Positions *Vehicle Type *SaloonConvertibleSportCoupeSteering Wheel Position *RightLeftPreviousNextCOMMUNICATIONChoose a communication method *PhoneE-mailWhat is the best time to contact you? *How did you hear about AIC Insurances? *Google SearchFacebookFrom a friend/acquaintanceEmail campaignOtherTerms and Conditions *I agree to the terms and conditionsWe will provide you with an insurance quote based on the information you have provided us. It is essential that all information and responses you enter are true and accurate, and all relevant information requested must be stated. Failure to provide accurate information and failure to declare all relevant data may result in the cancellation of your insurance and non-payment of claims. AIC Antigonos Insurances follows the principles of the GDPR (limitation of purpose, minimization of data, accuracy, limitation of storage period). The protection and security of your personal data is a matter of utmost importance to us. We are committed to always following these principles and advising you on how you prefer us to communicate with you.PreviousSubmission
