Request Quote - Auto Insurance Germany Your DataFirst name*Last name*Date of birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone number*Are you affiliated with NATO Forces?*YesNoWhere will the vehicle be registered?*USAREURBFGGerman registryAdditional InformationHave you had any accidents or claims in the last 5 years?YesNoAre you married?YesNoDo you already have a policy with us?YesNoIf yes, what is your policy number?Your VehicleYear of vehicle*202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993Please enter the year of the first registration. If the vehicle is older than 25 years please contact us 0800-MIRASCON (0800-64727266) or send us an email at contact@mirascon.com for a quote.Car make*Car model*Horse Power (hp)*Actual cash value in USD*If your auto value exceeds 80,000 USD, please contact us at 0800-MIRASCON (0800-64727266) or send us an email at contact@mirascon.com for a quote.Is there a lien on your vehicle?*YesNoLienholder nameYour Insurance CoverageThird Party Liability Insurance incl. Motor Assistance Coverage (mandatory)*YesComprehensive Coverage (e.g. theft, broken windshield, natural hazard)Deductible 300 EUR*YesNoCollision Coverage (own damage)Deductible 500 EUR (Note: If you select to have Collision Coverage, you will also carry Comprehensive Coverage with a 300 EUR deductible)*YesNoLoyalty Repair Program?*YesNoExpected start of insurance coverage (mm/dd/yyyy)*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PCS Date / DEROS (mm/dd/yyyy)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2030202920282027202620252024202320222021Data Processing* I have read and understood the Privacy Statement. CAPTCHA *required information