Coverage & Submit
Do you already have a policy with us?*YesNo
What is your policy number?
Are you affiliated with NATO Forces?*Not affiliatedAmerican Military / DoDExpats / Civilians
Date of Birth*
Year of vehicle*—Please choose an option—20242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990
VIN - Vehicle Identification Number
Actual Cash Value in USD* (max. value 20,000 USD)
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)*
Comprehensive Coverage (e.g. theft, broken windshield, natural hazard) Deductible 300 EUR*
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)*
Effective date of coverage*
PCS Date / DEROS
How did you find out about MIRASCON?—Please choose an option—Print Media Ads (Magazine, Flyer, Newspaper, etc.)Online Media Ads (e.g. bookoo, howtogermany, inkwire)Online Search (Google, Bing, etc.)Friends / Family / Work ColleaguesSocial Media (Instagram, Facebook, etc.)MIRASCON Website / NewsletterOther (e.g. Event)
10% Discount Active
Invalid Promotion Code
10% - 4th of July10% - USYS2023none
Third Party LiabilityThird Party Liability & Comprehensive CoverageThird Party Liability & Collision Coverage (incl. Comprehensive Coverage)
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I accept the privacy terms and conditions.*
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