GasanMamo Insurance - Motor Quote

Personal Motor Insurance Quotation

* Your Name:
Address:
Your Postcode:
* Your E-mail Address:
Your date of birth:
* Id Card Number
How long have you held a driving license?
* Your telephone number:
* Your occupation:
Vehicle make (i.e. Ford, Nissan etc.)
Vehicle model (i.e. Fiesta GLX, Nova SRi)
Engine size (i.e. 1600cc/1.6)
Year of manufacture:
* * Current value of vehicle:
Has the vehicle got an alarm?		Yes No
What is the name of the alarm?

Type of cover required: Comprehensive Third party fire and theft Third party only

Who is going to drive the vehicle: Yourself only You and your spouse (please state name and age of spouse) You and a named driver (please state name and age of driver) Any driver (please state age of youngest driver)

Have you or any other driver had any accidents or claims in the last five years?		Yes No
If yes, Please include details

Have you or any other driver been convicted of any motor offence?		Yes No
If yes, Please include details

Do you hold any other policies with GasanMamo Insurance?		Yes No
If yes, Please include details (Motor Registration Number is sufficient)

Will you use the vehicle for

Social and domestic use only
Travel to and from work
Work

Number of years or percentage No Claims Bonus that you hold
Would you like to transfer this No Claims Bonus to this car? (Need to pay an additional premium on your existing policy in order to transfer NCD.)		Yes No

How would you like to recieve your quotation?

Post

Fax

E-Mail

* These fields cannot be left blank

* * Not Required if you want to insure on Third Party Only Basis

Please specify if you want to receive updates on promotions, or any third party offers

Yes No

Data Protection Notice

To the extent that the information supplied by you, whether orally or in writing, constitutes personal data, including sensitive data within the provisions of the Data Protection Act, you consent to the processing of such data for purposes of administering your proposal for insurance, your Policy, underwriting, handling of claims and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. We maybe required to collect further information from our sub-agents, other insurance companies, insurance intermediaries or insurance associations.

In addition, we may pass some or all of the information to other insurance companies, or insurance associations for underwriting and claims handling purposes and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. This also helps us to check the information provided. When we deal with your request for insurance, we may search this information. When you tell us about an incident which may or may not give rise to a claim, we will pass information relating to it to the Malta Insurance Association.

We and other companies within our group would like, on occasion, to keep you informed of our products and services, by mail, fax, e-mail or other electronic means. Please inform us in writing if you do not wish to receive this information or if you wish to receive such information solely from GasanMamo Insurance Ltd. Moreover, were hereby ask you whether you wish to receive direct marketing information from us by e-mail to your e-mail address provided below.

You have the right to request access to, and rectification of, your personal data held by us by directing your request in writing signed by yourself to the Data Protection Officer, GasanMamo Insurance Ltd, Msida Road, Gzira GZR 1405

GasanMamo Insurance Limited is authorised to carry on business of insurance in Malta in terms of the Insurance Business Act 1998, regulated by the Malta Financial Services Authority. Company Registration Number: C3143