Send your request for an online offer below. After reception of the imported dates, we’ll contact you as soon as possible with a decent rate. Fields with a red asterisk must be filled in.Thank you in advance for your price request.Personal questions Name and first name * Specify the main driver’s name and first name Street and number * Residence or postal code * e-mail * Date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 How many accidents in fault * - Select -012>2 Last accident in fault? When? Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20212022202320242025 Bonus malus degree * - Select --2-101234567891011121314151617181920>20 Already customer at Kantoor Beernaert * Yes No Employment * - Select - Employee Official Worker Nurse Education Military Student Independent Other Vehicle dataData about the car you want to insure (see car papers or purchase invoice) Vehicle type * Car Motorcycle Light cargo Old timer Brand and type Brand and type * Cabrio * Yes No Fuel type * Gasoline Diesel Hybrid Electric Date of first traffic count * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20212022202320242025 See registration or scheduled date for newly ordered car Vehicle power in kW * You can find it on the vehicle’s registration you want to insure Car’s displacement (only for motorcycle rate) * You can find it back on the vehicle’s registration you want to insure Use * Private use Professional use Mixed Number of seats * - Select -2345678>8 Children within the family having a driving licence * Yes No Number of kilometres in one year with this vehicle * <5000 <10000 >10000 Catalogued price of the vehicle VAT included (when “omnium” desired) Invoiced amount VAT included (when “omnium” desired) % VAT recoverable Information current insurance Please note the data with regard to a possible current insurance policy/agent here Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Current company Please report the current company here Policy number Expiry date of the policy Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20232024202520262027202820292030203120322033 Your additional information or questions