2023 APPLICATION FOR MOTOR INSURANCE

Green Card Insurance Application

WITH PREMIUMS FOR MOTOR INSURANCE – EUROPE (MOTORCYCLES)
Green Card Insurance can only be issued during weekdays when our office is open and we need at least 2 days to process. It is often done quicker, but if you need it in a RUSH you must email us. Full comprehensive coverage will take us at least 2 business days to complete.
This Green Card Insurance card does not provide coverage for the country it is registered in.

Additionally it does not provide coverage for any of the countries listed below:

ALBANIA, ANDORRA, AZERBAIJAN, BOSNIEN HERZEGOWINA ,BELARUS, ISRAEL, IRAN, MOROCCO, MOLDOVA, NORTH MACEDOIA, MONTENEGRO, RUSSIA, SERBIA, TUNISA, TURKEY, UKRAINE.

(You should be able to purchase coverage at the border of these countries.)

LIABILITY ONLY is available for RV's and Passenger Cars are the same rates as Coverage 1 for Motorcycles.
Prices and Details
Please Note that this Green Card Insurance is not valid in the following countries: ALBANIA, ANDORRA, AZERBAIJAN, BOSNIEN HERZEGOWINA ,BELARUS, ISRAEL, IRAN, MOROCCO, MOLDOVA, NORTH MACEDOIA, MONTENEGRO, RUSSIA, SERBIA, TUNISA, TURKEY, UKRAINE.

You should be able to purchase coverage at the border of these countries.

There will be no coverage provided for a vehicle that is registered in Europe, in the country to which it is registered.
Select the type of Coverage you want from the dropdown list:*
What is the first day you need covered? Period from (Day, Month, Year)*

DayMonthYear
Date
What is the last day you need covered? Period to (Day, Month, Year)*

DayMonthYear
Date
COVERAGE 1 DETAILS

Bodily Injury € 2.500.000 per person, in case of death or injury of 3 or more persons a total of € 7,5 mio., limited to a total of € 2,5 mio. per injured person.

Property Damage € 1.000.000 Financial Damage € 50.000

(each claim)

Third Party Liability for Passenger Cars and Trailers is the same premium as motorcycles listed below.
COVERAGE 2 DETAILS

The insurance is based on the ADS 1973 as amended 1994.

Full coverage is agreed on, excluding paint blemishes and scratches.

Written conditions have priority over printed conditions.

The laws of Germany shall apply, place of jurisdiction shall be Hamburg.

The limit of indemnification per insured motorcycle is € 20.500, maximum for accessories and improvement/ finishing is € 2.500. The deductible for each claim is € 500.

No indemnity for theft in Russia, Ukraine, Poland, Hungary, Bulgaria, Croatia, Albania, Serbia, Bosnia, Latvia, Lithuania, Moldavia, Czech Republic, Macedonia, Rumania, Turkey, Iran, Israel, Morocco, Tunisia.
A $60 Policy Fee will be added to coverage and included in your total.
COVERAGE 1 Third Party Liability -Select number of months from the dropdown list. Prices Listed Here. REQUIRED TO SELECT ONE
COVERAGE 2 - Third Party Liability INCLUDING Comprehensive with Fire, Theft, Vandalism and Collision. Select number of months from the dropdown list. Prices Listed Here. REQUIRED TO SELECT ONE
Select the Additional Coverage for your Trailer -Trailers are only eligible for Third Party Liability REQUIRED TO SELECT ONE
APPLICATION FOR MOTOR INSURANCE – EUROPE (MOTORCYCLES)
Applicant
Last Name*
First Name*
Address*
City, State/Province, Zip*
Country*
Phone*
E-Mail*
example@example.com
Date of Birth (Please enter in European format ex. DD/MM/YYYY)
Description of the motorcycle OR Passenger Car or RV
Make*
Year*
Model*
Plate Number*
Country of Registration*
Vehicle ID No.*
Actual Value in €*
TRAILER
Trailer Make
Trailer Year
Trailer Type
Trailer Plate Number
What Country is your trailer registered in?
Trailer Vehicle ID No.
Trailer Actual Value €
Declared value incl. supplementary equipment (in €) if applicable. This value will be the basis for your claim.
Review & Confirm for Payment
Policy Fee*
I understand my Green Card Insurance Card will be EMAILED Electronically to me - No Mailing Fee Cost - and I understand I must have color printer to Print a copy of it.*

Yes
Please RE-CONFIRM how many months will you need coverage for?*
Total
The conditions „Allgemeine Kraftfahrt Versicherungsbedingungen“(AKB) of the AXA Versicherung AG as amended from time to time shall apply.
AXA Versicherung AG/TourInsure GmbH, Herrengraben 5, 20459 Hamburg, Tel.: +49 (0)40 / 25172150, Fax: +49 (0)40 / 25172121 E-Mail: Service@Tourinsure.de, Internet: www.TourInsure.de
DateTime
Signature*

Clear
*** IMPORTANT NOTE: Once you enter your payment information, you will be brought back to this form and you MUST hit the SUBMIT button to complete your application.

You will then receive an email receipt that will have all of your entered information and a payment receipt attached.

Note: If you are applying for Green Card Insurance and you are over 65, you will need to email a note from your physician saying you are in good health to ride. Email to: info@motorcycleexpress.com ***

Total

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Green Card Insurance Application

Prices and Details

APPLICATION FOR MOTOR INSURANCE – EUROPE (MOTORCYCLES)

Applicant

TRAILER

Review & Confirm for Payment