Personal Information
Vehicle Information
Coverage & Submit
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I understand that this insurance is not intended for rental cars, nor for covering your (US) car for holidays / vacation in Germany.*
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*—Please choose an option—2023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990
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.
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Name*
Email*
I accept the privacy terms and conditions.*
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