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      Personal Information

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      Vehicle Information

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      Coverage & Submit

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    Personal Information

    First Name*

    Last Name*

    Personal Email*

    Phone Number*

    Are you affiliated with US/NATO Forces?* YesNo

    Where will the vehicle be registered?*USAREURGerman registry

    Duty Station/Location in Germany*

    Are you married?*YesNo

    Date of Birth*

    Are you currently insured with GEICO?YesNo

    GEICO policy number

    Motorcycle make*

    Motorcycle model*

    Year of vehicle*

    VIN - Vehicle Identification Number

    Horse Power

    Actual Cash Value in USD* (max. value 20,000 USD)

    2nd Driver Information

    2nd Driver First Name

    2nd Driver Last Name

    Is there a lien on your vehicle?*YesNo

    Have you had any at-fault accidents in the last five years?*YesNo

    Third Party Liability Insurance incl. Motor Assistance Coverage (mandatory)*[tooltips "

    Third Party Liability - for damages caused to others by your vehicle Covers damages if the use of your vehicle

    causes injury to or the death of a person, damages or destroys property, or such property is lost, causes economic losses which are neither directly or indirectly connected with damage to persons or property, and if claims for damages are made towards you or your liability insurer due to liability conditions for motor vehicles, which are also defined by the Law on mandatory insurance of the responsibility for motor vehicles, also defined as German Civil Code or the Road Traffic Law, or due to other legal liability conditions of private law. Limits: 100 million EUR per year and 12 million EUR per each bodily injury

    This is general information and is not legally binding.

    "]

    Comprehensive Coverage (e.g. theft, broken windshield, natural hazard) Deductible 300 EUR*[tooltips "

    Comprehensive — Including Windscreen / Window Clause

    Covers damage caused to the insured vehicle by the following perils: fire, theft, burglary, glass, or vandalism in connection with theft (only if the intention was theft). This insurance has a deductible of EUR 300. Comprehensive coverage does not include use of a rental car in the event of a covered loss or roadside assistance. If a window is broken by any cause and it can be repaired, it will be repaired free of charge. If the window needs to be replaced, a deductible of EUR 300 will apply.

    This is general information and is not legally binding.

    "]
    YesNo

    Collision Coverage (own damage) Deductible 300 EUR (Note: If you select to have Collision Coverage, you will also carry Comprehensive Coverage with a 300 EUR deductible)*[tooltips "

    Collision Loss/Full - Including Comprehensive:

    In addition to the coverage given under Comprehensive above, this insurance covers damage caused to your vehicle from vandalism and damage to your vehicle due to COLLISION. This insurance has a deductible of EUR 500 for cars and EUR 300 for motorcycles. Collision Loss/Full coverage does not include use of a rental car in the event of a covered loss or roadside assistance.

    This is general information and is not legally binding.

    "]
    YesNo

    Effective date of coverage*[tooltips "

    If unsure, what day do you expect your vehicle to arrive in Germany?

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    PCS Date / DEROS

    I hereby consent to my data submitted in the contact form being collected and processed in order to answer my request.