• 1

      Personal Information

    • 2

      Vehicle Information

    • 3

      Coverage & Submit


    Personal Information

    First Name*

    Last Name*

    Personal Email*

    Phone Number*

    Are you affiliated with US/NATO Forces?* YesNo

    Where will the vehicle be registered?*USAREURGerman registry

    Duty Station/Location in Germany*

    Are you married?*YesNo

    Date of Birth*

    Are you currently insured with GEICO?YesNo

    GEICO policy number

    Motorcycle make*

    Motorcycle model*

    Year of vehicle*

    VIN - Vehicle Identification Number

    Horse Power

    Actual Cash Value in USD* (max. value 20,000 USD)

    2nd Driver Information

    2nd Driver First Name

    2nd Driver Last Name

    Is there a lien on your vehicle?*YesNo

    Have you had any at-fault accidents in the last five years?*YesNo

    Third Party Liability Insurance incl. Motor Assistance Coverage (mandatory)*

    Comprehensive Coverage (e.g. theft, broken windshield, natural hazard) Deductible 300 EUR*

    Collision Coverage (own damage) Deductible 300 EUR (Note: If you select to have Collision Coverage, you will also carry Comprehensive Coverage with a 300 EUR deductible)*

    Effective date of coverage*

    PCS Date / DEROS