BMI - Automobile Form

Vehicle Details

Vehicle type Make

Model Nº Doors

Fuel License plate type

Cylinder capacity C.C. Vehicle country of origin

Date of matriculation: mm/yyyy / License plate

For motorbikes and similar only:
Vehicle type Make

Driver's Details

Gender

Marital Status

Name

N.I.E. or D.N.I.

e-mail

Phone number

Postal code

Date of birth:

dd mm yyyy

Date of driving license:

dd mm yyyy

Vehicle's owner

Usual driver

If the vehicle has many drivers, state the youngest and/or least experiences:

Age

Years of driving license

Policy Details

Are you currently insured?

Yes No

Insurance company

Years insured

Bonus %

Policy number

Comments