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1. ENTER YOUR INFORMATION

* Required field

First name*

Last name*

Postal Code*

E-mail*

Car Insurance Renewal Date*

VIN (Vehicle Identification Number)*

2. What We Need from You

To get started and receive your personalized quote, we require your authorization for the processing of your past 3 months of connected car data, below indicated, only to send them to Stellantis Insurance Ltd and give to Stellantis Insurance Ltd the possibility to send you a personalized car insurance quote.

If you click on “Submit” you authorize us to share the above indicated data for this purpose.

What Connected Data are you authorising us to share?

1. Date & Time
2. Speed
3. Direction
4. Outside Temperature
5. Luminosity
6. Speed Limit

Getting to know you better

To provide you with the most accurate quote, please also provide the following information:

Telephone Number*

Preferred Language:

Dutch
French

Please correct the highlighted fields and try again.

Lead Type Code

Customer Type Code

Lead Channel Code

Lead Source Code

Lead Request Type Code

Activity

Thank you for your query

A member of our team will be in touch with you shortly.