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      Personal Information

    • 2

      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

    Car Make*

    Car Model*

    Year of Vehicle*

    VIN - Vehicle Identification Number

    Horse Power

    Actual Cash Value in USD* (max. value 95,000 USD)

    2nd Driver Information

    2nd Driver First Name

    2nd Driver Last Name

    Is there a lien on your vehicle?YesNo

    Lienholder Name:

    Lienholder Address:

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

    Third Party Liability Insurance incl. Motor Assistance Coverage (mandatory)*
    Yes

    Important note: Comprehensive and collision coverage are only available for cars not older than 10 years. However, cars financed by a bank are required to get full coverage (comprehensive & collision).

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

    Collision Coverage (own damage) Deductible 500 EUR (Note: If you select to have Collision Coverage, you will also carry Comprehensive Coverage with a 300 EUR deductible)*
    YesNo

    Loyalty Repair Program?*
    YesNo

    Effective Date of Coverage*

    PCS Date / DEROS

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