Your Quote Details

GET REWARDED FOR YOUR SAFE DRIVING WITH CHEAPER INSURANCE FROM AIG

YOU QUALIFY FOR AIG BOXCLEVER, OUR TELEMATICS INSURANCE POLICY DESIGNED SPECIFICALLY FOR DRIVERS AGED 27 AND UNDER

* Pre-contractual duty of disclosure

You must answer all questions contained in this application form honestly and with reasonable care. Failure to do so may result in your policy being cancelled or we may refuse to deal with any claims or reduce the amount of a claim payment, as detailed under the Impact of Misrepresentation section, which you should read carefully.

The answers you provide are the basis upon which an insurance cover quotation will be offered or refused.

1. Your Details
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Please enter your details in all the fields below.

Title

First name

Last name

Email Address

Contact number*

*We may call you in relation to your quotation

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2. Your Information
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Your Address/Eircode
Cannot find address?

Billing Address

Please note the above risk address will be used as your billing address. If this is not your billing address click here.

Your Billing Address/Eircode
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How long have you been a permanent resident in Republic of Ireland?

* How long have you been resident in Ireland and/or the UK?

Date of Birth

Sex

Male
Female

Employment status

Your occupation?

What type of driving licence do you hold?

Full Irish

Learner Permit

Full EU

UK / International

When did you obtain this driving licence?

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3. Insurance Details
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Your most recent driving experience

Will you use this car to commute to work?

Will you use this car in connection with your work?

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4. Kilometre Details
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AIG BoxClever is a kilometre based policy. It’s important you estimate as accurately as you can, the number of kilometres you need to drive for the full cover period of this policy.

Should you reach your kilometre limit, we will inform you by email and text that you need to buy top up kilometres to continue your insurance cover. If you run out of kilometres within the final 3 months of your policy period and have demonstrated safe driving behaviour, as a reward you may not be required to top up and AIG will inform you in advance by email and text

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6. Claims
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Have you had any claims or accidents in the last 5 years regardless of blame?

Incident date

Incident type

Is the claim now fully settled?

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7. Penalty Points
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Do you have any active or pending penalty points on your licence?

Type of offence

On what date were the penalty points received?

Number of penalty points for this offence?

* Number of penalty points received

Were these penalty points applied due to a judgement in a court of law?

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* Pre-contractual duty of disclosure

1. Your Details
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2. Your Information
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Address

Billing Address

Billing Address

3. Insurance Details
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4. Kilometre Details
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4. Vehicle Details
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5. Additional Drivers No Additional Drivers - Add Driver +
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6. Claims
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7. Penalty Points
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8. Eligibility Questions
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* Pre-contractual duty of disclosure

Address

Billing Address

Billing Address

Driver Details