Request Quote - Auto Insurance Germany Your DataFirst name*Last name*Date of birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone numberAre you affiliated with NATO Forces?*YesNoWhere will the vehicle be registered?*USAREURBFGGerman registryPCS Date / DEROS MM DD YYYY Additional InformationHave you had any accidents or claims in the last 5 years?YesNoAre you married?YesNoWhat is your present insurer?Do you already have a policy with us?YesNoIf yes, what is your policy number?Your VehicleYear of vehicle*199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021Please enter the year of the first registration. If the vehicle is older than 25 years, please contact MIRASCON at 0800-MIRASCON (0800-64727266) or send us an email at contact@mirascon.com for a quote.Car make*Car model*Horse Power (hp)*Actual cash value in USD*If your auto value exceeds 80,000 USD, please contact us at 0800-MIRASCON (0800-64727266) or send us an email at contact@mirascon.com for a quote.Is there a lien on your vehicle?*YesNoLienholder nameYour Insurance Coverage Third Party Liability Insurance incl. Motor Assistance Coverage Comprehensive Cover: Deductible 300 Euro Full Coverage (incl. comprehensive cover): Deductible 500 Euro (300 Euro) Loyalty Repair Program Effective date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Data Processing* I have read and understood the Privacy Statement. CAPTCHA *required information