0. Preamble
0.1. You are
Current resident in Luxembourg
Future resident in Luxembourg
0.2. Your vehicle is
already registered in Luxembourg
being registered in Luxembourg
0.3. Your request is about insurance for
Car
Exceptional vehicle
Commercial car
Van
0.4. The vehicle you wish to insure is
your current vehicle already insured (Luxembourg or abroad)
a new acquisition (first or sole vehicle)
a new acquisition and replaces the previous vehicle
a new acquisition and will become your main vehicle (in addition to a secondary one)
a new acquisition and will become your secondary vehicle
0.5. Your Goal
Finding a better deal for a car already insured in Luxembourg
Find the best deal for your new car
Insuring your car after moving to Luxembourg
Audit your coverage
1. Identification of the policyholder
Frist name
Last name
1.3. Date of birth
Place of birth
1.4. Nationality
Nationality 2
Nationality 3
1.5. Mailing address
.
.
.
1.6. Email
Phone
Phone 2
2. Driver's licence
2.1. Driver's licence type
2.2.Date of issue of driving licence
2.3. Civil Liability Bonus/Malus
Bonus -3 ------> 45 % of the base premium
Bonus -2 ------> 45 % of the base premium
Bonus -1 ------> 45 % of the base premium
Bonus 0 ------> 47,5 % of the base premium
Bonus 1 ------> 50 % of the base premium
Bonus 2 ------> 55 % of the base premium
Bonus 3 ------> 60 % of the base premium
Bonus 4 ------> 65 % of the base premium
Bonus 5 ------> 70 % of the base premium
Bonus 6 ------> 75 % of the base premium
Bonus 7 ------> 80 % of the base premium
Bonus 8 ------> 85 % of the base premium
Bonus 9 ------> 90 % of the base premium
Bonus 10 ------> 100 % of the base premium
Base 11 ------> 100 % of the base premium
Penalty 12 ------> 105 % of the base premium
Penalty 13 ------> 110 % of the base premium
Penalty 14 ------> 115 % of the base premium
Penalty 15 ------> 120 % of the base premium
Penalty 16 ------> 130 % of the base premium
Penalty 17 ------> 140 % of the base premium
Penalty 18 ------> 160 % of the base premium
Penalty 19 ------> 180 % of the base premium
Penalty 20 ------> 200 % of the base premium
Penalty 21 ------> 225 % of the base premium
Penalty 22 ------> 250 % of the base premium
2.4. Material damage Bonus-Malus
-3
-2
-1
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
3 Risk identification and use of the vehicle
3.1. Do you have a garage / private box?
If YES, does it have an anti-theft alarm connected to a central?
Address of garage/box if different from 2.5)
3.2. Vehicle usage
Private only
Professional only
Private and Professional
Private and working way
Special usage
Driving school
Ambulance for free
Firefighter
Hearse
3.3. Driver type
one driver
Multiple drivers (family)
if multiple drivers
Date of bith
Date of issue of driving licence
3.4. Do you use a vehicle other than this one?
if YES
More often
Less often
Rarely
N / A
If yes: Car brand, Model, version, registration number (plate number)
4. Estimation of Vehicle valuation
4.1. Purchase of the vehicle
Date of purchase
4.2. Condition when purchased
New vehicle
Used vehicle purchased from a garage
Used vehicle not purchased from a garage
4.3. Vehicle: Year of manufacture
4.4. Date of the 1st time the vehicle was put into circulation
4.5. Vehicle value (excl. VAT)
(incl. VAT)
(incl. VAT & excl. options)
4.6. VAT recovery (%)
5. Visual appearance of the vehicle
5.1. Current condition of the vehicule
5.2. car body
Sedan / Berline
Break
convertible / Cabriolet
Mini vanonospace
SUV
5.4. How many doors in the vehicle
How many seats in the vehicle
5.5. Fuel (Box P3 on the registration card)
Diesel
Gasoline
Electric
Hybrid
LPG
Other
5.6. Are you driving per year, less than
5 000 km
7 000 km
8 000 km
9 000 km
10 000 km
15 000 km
20 000 km
No limit
5.7. Current Kilometrage (km)
Statement date
5.8. Smart Car (must have the 3 options: Active Blind Spot Assist + lane-departure warning + Brake Assist )
Vehicle fitted with an IA2/VV2 alarm system (audible alarm + circuit breaker)
Geolocation (With the subscription)
6. Vehicle: technical characteristics
6.1. Licence plate
6.2. Vehicle identification number (VIN)
6.3. Car brand
Model
Version
6.4. Capacity (cm3)
Power (kw)
Maximum Mass Authorised
CO2 EmissionS
7. Questions
7.1. Has your driver's license ever been revoked?
If yes explain
7.2. Has an insurer ever paid compensation for damage caused by you?
If yes explain
7.3. Any insurance policy has already been refused or terminated by an insurer for?
non-payment of insurance premiums
frequency of claims
other reasons
NO
If YES, specify dates and reasons
7.4. Number of responsible claims in MATERIAL DAMAGE over the last 5 years
If any specify dates and reasons
7.5. Have you had a "total theft" claim in the past 4 years?
If YES, specify dates and reasons
8. Choice of garanties
8.1 What are you looking for ?
A1) Mandatory minimum protection (third-party insurance) --> U 1-2
A2) Mandatory PLUS minimum protection
B1) Intermediate protection (Mini casco/omnium): --> U 1-2-3-4-5-6
B2) Intermediate coverage PLUS
C) Maximum protection (casco/all risks/omnium): --> U 1-2-3-4-5-6-7
C5-Road accident insurance
NO
Death: €10,000 - Disabilities: €30,000 - Medical expenses: €2,500
Death: €20,000 - Disabilities: €60,000 - Medical expenses: €2,500
Death: €40,000 - Disabilities: €120,000 - Medical expenses: €2,500
Others to specify in comments
C6- Driver injury insurance
9. Complement
9.1. Is the vehicle already insured?
YES, in Luxembourg
YES, abroad
NO
If so, by which insurer?
9.2. 46. Have you already been in touch with another insurance intermediary (agent, broker) for this car insurance:?
If so, which insurers have already been contacted?
9.3. PROMO CODE (Aurels Luxembourg) or NAME of your Aurels Advisor
10. You are requested to send us (if necessary)
1) A copy of your registration card (carte grise);
2) A copy of your ID card
3 ) A copy of your curent car insurance
4) A copy of your bonus/penalty certificate
5) A copy of your driver's licence
6) A copy of the proof for subscription to geolocalisation
7) A copy of the the statement of the car's condition
4) Any other document you find useful
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