Insurance Agent For English Speakers in France
Your car quote
Where did you hear about AXA Agence International?
I am an existing client of Agence AXA International
Currencies Direct
Ryanair
Iter
Vingt Paris
Valorama
The Connexion newspaper
English Spoken
French Entree
The Grapevine Directory
Facebook
Google Search
Relocation company or Estate Agent
Exhibition
Recommendation
Other
Other
What is the name of the relocation agency, estate agent, person who recommended us, or which exhibition
Car registration (i) If you don’t know the registration number, please put 31XXX31
Is the vehicle currently registered outside of France ?
Yes
No
For us to insure a foreign registered vehicle we require you to have at least one additional policy with us
I am an existing Agence AXA International client with 1 or more contracts
I am not currently a client but I have other contracts to arrange
I do not have any additional policies to arrange
Vehicle make (i) Your vehicle's make can be found in the D.1 section of your carte grise
Vehicle model (i) Your vehicle's model can be found in the D.3 section of your carte grise.
Please write the vehicle model type if it is not in the list above
Fuel type (i) The type of fuel can be found in the P.3 section of your car registration document
What is the specific version of your vehicle? i.e. comfort, sport
What is the CV of your vehicle? (horse power) (i) section P.6 on your car registration document
If you don’t know the CV of your vehicle please let us know the CC (cylinder capacity)
Date of manufacture (i) top right hand corner on a carte grise (Format DD/MM/YYYY)
If available, please complete the vehicle type mine/variant number if available (i) section D.2 on the registration document
Gearbox
AUTOMATIC
MANUAL
Means of purchase
Purchased with your own funds
Funded with a personal loan
Leasing
Long-term rental
If you already own the vehicle, what is the date when your vehicle was registered in your name? (i) written next to the registration number on the bottom third of the carte grise, section 5 on a V5. Location will vary depending on the country of issue (Format DD/MM/YYYY)
ADRESS WHERE VEHICLE IS KEPT OVER NIGHT
First line of your address
Additional address details
Additional address details
Post code
Town/Village
Type of garage
Individual lock-up - within gated premises or garage of your house, or individual garage in underground parking
Collective lock-up - parking place in an underground or outdoor lock-up garage with access for other users
Other
Is it a
House
Apartment
Are you the
owner
tenant
other
Is the main driver named as the owner on the registration document (or lessee in the case of leasing) ?
Yes
No
Who is the vehicle registered to?
The registration document is in the name of the partner of the main driver
The registration document is in the name of a parent/grandparent of the main driver
Other situation
Title
Mr
Mrs
Miss
Surname
First name
Date of birth (Format DD/MM/YYYY)
Same as address where car is parked overnight?
Yes
No
CORRESPONDANCE ADDRESS
First line of your address
Additional address details
Additional address details
Post Code
Town/City
Country
Mobile telephone number
Country Code
+33
+44
+31
+49
+34
+39
+48
+679
+358
+594
+689
+241
+220
+995
+233
+350
+30
+299
+1-473
+590
+1-671
+502
+224
+245
+592
+509
+504
+852
+36
+354
+91
+377
+976
+1-664
+212
+258
+95
+386
+263
+975
+591
+387
+267
+55
+673
+359
+226
+257
+855
+237
+1
+238
+1-345
+236
+235
+56
+86
+53
+61
+57
+269
+243
+242
+682
+506
+225
+385
+53
+357
+420
+45
+253
+1-767
+1-809 and +1-829
+670
+593
+20
+373
+677
+260
+93
+355
+213
+1-684
+376
+244
+1-264
+672
+1-268
+54
+374
+297
+61
+43
+994
+1-242
+973
+880
+1-246
+375
+32
+501
+229
+503
+62
+98
+964
+353
+972
+1-876
+81
+962
+691
+264
+674
+977
+599
+687
+421
+218
+423
+370
+352
+853
+389
+261
+265
+60
+960
+223
+356
+692
+596
+222
+230
+269
+52
+7
+254
+686
+850
+965
+996
+856
+371
+961
+266
+231
+82
+64
+505
+227
+234
+683
+672
+1-670
+47
+968
+92
+680
+970
+507
+675
+595
+51
+63
+351
+1-787 or +1-939
+974
+262
+40
+7
+250
+290
+1-869
+1-758
+508
+1-784
+685
+378
+239
+966
+221
+248
+232
+65
+252
+27
+94
+249
+597
+268
+46
+41
+963
+886
+992
+255
+66
+690
+676
+1-868
+216
+90
+993
+1-649
+688
+256
+380
+971
+1
+598
+998
+678
+418
+58
+84
+1-284
+1-340
+681
+1-441
+967
+240
+291
+372
+251
+500
+298
Email address
Marital Status
Single
Living together
Married
Divorced
Separated
Widowed
Occupation
Employee
Cadre
Civil servant
Student
Retired
Self-employed
Not working
Job Title
Date you obtained your driving licence (Format DD/MM/YYYY)
Use of the vehicle
Private - Private trips, excluding all professional trips or commuting
Private + commuting - Private use and commuting to one or several fixed places of work
Professional - Private and professional trips, excluding regular rounds/routes
Rounds - Regular use of the vehicle to visit clients, patients, agencies, warehouses, offices, building sites...
Post Code of place of work
Town/City of place of work
How many vehicles are there in the household? (i) Motor homes and classic vehicles should not be included in the number of household vehicles
How many people in the household have a driving licence? (i) These are people usually living under the same roof as the main driver, and their financially or fiscally dependent children.
Has anyone included in this figure held their full driving licence for less than 36 months?
Yes
No
Would you like to add your partner as a named driver?
Yes
No
Surname partner
Firstname partner
Date of birth (Format DD/MM/YYYY)
Date they obtained their driving licence (Format DD/MM/YYYY)
Are they insured on a vehicle in their own name?
Yes
No
How many months of the last 24 has the main driver been insured
Is the vehicle
Currently owned by you
A vehicle you are purchasing to replace your current vehicle
An additional vehicle
How long have you owned your current or previous vehicle?
Less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years or more
Has your current policy ended?
Yes
No
What date did the policy end? (Format DD/MM/YYYY)
Will the current policy continue?
Yes to insure a different vehicle
No the policy will be cancelled
Please indicate the end-date of your policy, meaning the date on which you are not (or will no longer be) insured with your current insurer (Format DD/MM/YYYY)
Will you drive more or less than 8 000 km per year?
less than 8 000 km per year
more than 8 000 km per year
Number of declared claim(s) in the last 36 months (i) include all claims, at fault or not, including windscreen repair/replacement
no claims
1
2
3
4 or more
Date of claim 1
Type of claim 1
Total
Partial
Not responsible
Parking
Theft
Fire
Windows or headlights
Date of claim 2
Type of claim 2
Total
Partial
Not responsible
Parking
Theft
Fire
Windows or headlights
Date of claim 3
Type of claim 3
Total
Partial
Not responsible
Parking
Theft
Fire
Windows or headlights
Name of your current or previous insurer
If applicable, what is your current French bonus (please only answer if you have a current or recent French insurance policy)
1,50
1,49
1,48
1,47
1,46
1,45
1,44
1,43
1,42
1,41
1,40
1,39
1,38
1,37
1,36
1,35
1,34
1,33
1,32
1,31
1,30
1,29
1,28
1,27
1,26
1,25
1,24
1,23
1,22
1,21
1,20
1,19
1,18
1,17
1,16
1,15
1,14
1,13
1,12
1,11
1,10
1,09
1,08
1,07
1,06
1,05
1,04
1,03
1,02
1,01
1,00
0,99
0,98
0,97
0,96
0,95
0,94
0,93
0,92
0,91
0,90
0,89
0,88
0,87
0,86
0,85
0,84
0,83
0,82
0,81
0,80
0,79
0,78
0,77
0,76
0,75
0,74
0,73
0,72
0,71
0,70
0,69
0,68
0,67
0,66
0,65
0,64
0,63
0,62
0,61
0,60
0,59
0,58
0,57
0,56
0,55
0,54
0,53
0,52
0,51
0,50
How many years no claims bonus can you prove? - If you have proof of driving experience and history of insurance from outside France, please include this as we can take this into consideration
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 or more years
In the last 3 years
Have you had your licence cancelled or suspended for more than 45 days?
Yes
No
Had insurance refused or cancelled?
Yes
No
Have you been convicted or fined for fleeing the scene of an accident?
Yes
No
Within the last 5 years have you been convicted or fined for driving while intoxicated or under the influence of drugs?
Yes
No
When would you like your insurance policy to begin? (Format DD/MM/YYYY)
Level of cover required
3rd party liability only
3rd party liability, fire, and theft
fully comprehensive
Breakdown assistance 24/7 in under 1 hour
Yes
No
Replacement hire car
Yes
No
Excess/deductible for windscreen, window and headlight repair and replacement reduced to 0€
Yes
No
Driver safety extended to €450,000.
Yes
No
How would you like to pay?
Annual by direct debit (i) this is the most cost effective
Annual
Monthly
Driver Licence
Select file...
Proof of no claims
Select file...
Carte Grise
Select file...
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