2021-2022 APPLICATION FOR MOTOR INSURANCE

Green Card Insurance Application

WITH PREMIUMS FOR MOTOR INSURANCE – EUROPE (MOTORCYCLES)
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.)
Prices and Details
How many months will you need coverage for? (This question is emphasized on the application more than once for internal office needs. Thank you, for being thorough.) *
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) *

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

Day Month Year
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.
COVERAGE 2 - Third Party Liability INCLUDING Comprehensive with Fire, Theft, Vandalism and Collision. Select number of months from the dropdown list. Prices Listed Here.
Select the Additional Coverage for your Trailer -Trailers are only eligible for Third Party Liability
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
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
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 ***

Green Card Insurance Total

USD Description

Payment Method

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