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Choosing the conditions of the estimate

Please complete the details below
Please note that your answers may disqualify you from receiving an estimate or application

Name
(first name / family name)
E-Mail

confirmation

Daytime Contact Number
- -
Home address
postcode / zip code
Prefecture 

ex. 703 Green Heights Bldg , 1-9-22 kyobashi Chuo-ku

Questions about the automobile to be insured.

Q1

Please write down the vehicle code (kata-shiki), the manufacturers name and model of vehicle. Refer to the Shaken document. check here

・Manufacturers name, model, year of vehicle

ex.TOYOTA Harrier 2006

・vehicle code(型式 : katashiki)

ex.GF-AT211
Q2

Vehicle's current value

Yen(円)
Q3

Initial registration date.(初度登録 : Shodotouroku)

    Date(YYYY/MM)
Q4

Select the purpose of your car.

Q5

The main driver's date of birth.

    Date(YYYY/MM/DD)

Youngest driver in family.

Q6

Other people beside the family member will drive the car occasionally

Q7

Select the color of your driver's license.

Questions about current automobile insurance.

Q8

Do you have auto insurance currently?

Q9

Current policy maturity date
(If you don't have insurance, when would you like it to commence)

 
Q10

How many times have you had an accident in the last year?

Q11

Please select the non-fleet rating*

 More Info

If you don't know your rating, please select '6'.
note: Driving experience overseas doesn't apply in Japan.

Q12

When would you like to start the policy from?

ex. July 1st , ASAP etc.

(*) Please select the rating as stated in the current insurance policy.
When refering to the maturity information please be sure not to select a grade above the current rating.
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