About Car

  
    When do you want your insurance policy to start (within 30 days)?    
       
    What's the Make and Model of your Card       
     
    Year Of Construction/Registration?    
     
    How much is the car currently worth (market value in AED)?    
       
    Does the car have any modifications? What counts as a modification?    
       
    When did you start driving this car?  
  
 
I don't have the car yet
       
    Are you the owner and the registered keeper of the car?  
YES NO
  
       
    What do you use the car for?    
       
    Roughly how many km does your car cover in a year?    
       
    Where is your car usually kept over night?   Garage Street Drive  
       
    Where is your car usually kept during the day?   Garage Street Drive  
       
    Total number of cars in your household (including this one)    
       
   

Personal Info.

  
    First name Surname    
       
    What is your gender?   Male Female  
       
    Date of Birth    
       
    Marital Status    
       
    How many children under 16 do you have?    
       
    Are you a homeowner?   YES NO  
       
    Your Address    
       
    Phone Number:    
       
    What do you do for a living? For example: Teacher, Receptionist, Retired, Student, etc    
       
    What's your employer's business type?    
       
    Do you have an additional job?   YES NO
 
           
    What do you do for your additional job?    
       
    For this job, what is your employer's business type?    
       
    Have you made any car insurance claims in the last 5 years?   YES NO  
       
    Have you had any driving offences in the last 5 years?   YES NO  
       
   

About Your Driving

  
       
    What type of driving licence do you hold?    
       
    How long have you held this licence?    
       
    Tell us how long you've held your current driving licence. Check on the licence for the 'valid from' date    
       
    How many years no claims discount do you have?    
       
    Would you like to protect your no claims discount?   YES NO  
       
    Do you have any medical conditions that affect your driving?   YES NO  
       
    Have you ever been declined car insurance?   YES NO  
       
    Do you drive any other car?   YES No  
       
    What voluntary excess would you like on this policy?    
       
    How would you prefer to pay for your car insurance?   Yearly Monthly  
       
   

Results

  
       
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