旅居車保險估價 Motor Home Insurance Quote

駕馭自由，保障隨行！
Drive with freedom, coverage that goes with you!

Primary Driver Name 主要駕駛人姓名

電郵 Email

生日 Birthday

Month

Day

Year

電話 Phone

性別 Gender

駕照號碼 Driver License #

首次領照年份 First Licensed Year

選擇辦公室 Select Office

您偏好的溝通語言 Preferred Language

微信 WeChat ID

停放地址 Garage Address

郵寄地址 Mailing Address (若與停放地址不同 if different from garage address)

需要新估價的原因 Reason for New Quote

您是如何得知我們的？How did you hear about us?

目前是否已承保? 哪間保險公司? 到期日? Currently insured? which company? expiration date?

請上傳目前保險的保單證明文件 Please upload a copy of the current insurance's declaration page

是否曾有事故紀錄 Any known prior claim?

若曾有事故或是罰單，請寫下年份及描述 Please provide the year and a brief description of any past claims & traffic tickets:

駕駛旅居車有多少年經驗？How many years of experience has the driver had operating a Motor Home?

是否參加過旅居車安全課程？Has the operator taken a Motor Home safety course?

是否需要提交 SR-22 責任證明文件Is a financial responsibility filing (SR-22) required?

年份、品牌和型號 Year, make, model

引擎號 VIN#

目前總里程數 Current Odometer Reading

長度和重量 Length and weight

購買日期 Purchase Date

購買價格 Purchase price

使用方式 Usage

每年預估使用天數 Estimated number of usage days per year

會出租給其他人? Will rent to others?

其他駕駛人（如有需要）Additional Drivers (if needed)

姓名 Full Name

生日 Birthday

性別 Gender

關係 Relationship

駕照號碼 Driver License #

首次領照年份 First Licensed Year

姓名 Full Name

生日 Birthday

性別 Gender

關係 Relationship

駕照號碼 Driver License #

首次領照年份 First Licensed Year

備註 Additional Notes

旅居車保險估價 Motor Home Insurance Quote

駕馭自由，保障隨行！ Drive with freedom, coverage that goes with you!

駕馭自由，保障隨行！
Drive with freedom, coverage that goes with you!