Submit vehicle change online to Alpina.

Old vehicle data

Enter the details of the old vehicle here.

Brand and type*

License plate*

Enter the license plate number here.

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License plate*

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Brand

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Model

New vehicle data

Enter the details of the new vehicle here.

Type of use.*

Private (and commuting).

Business

Lease car

Yes

No

Type of vehicle*

Choose the type of vehicle you wish to insure here.

Date of birth of youngest driver*

Type of scooter/moped

Brand and type*

License plate*

Enter the license plate number here.

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License plate*

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Brand

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Model

Chassis Number/Marking Code.*

These are the last four digits of the chassis or frame number. Click here for more information on the report code.

Business use*

Data is verified and correct

Desired coverage and effective date

Date of entry*

The effective date cannot be in the past.

Desired coverage*

Choose your desired coverage here. Click here for more information on possible coverages.

Civil liability (WA)

WA + Limited casco

WA + Casco (All-Risk)

Desired coverage*

Choose the desired coverage here.

Civil liability (WA)

WA + Theft

Third party liability + Theft and fire

WA + Theft, fire and collision

Daily Value*

Enter the current value of the vehicle here.

Catalog Value/New Value*

Number of miles per year*

Enter here how many miles per year you will drive the vehicle.

Co-insure older vehicle?*

If the old vehicle has not yet been sold, you can co-insure it for up to 14 days on third-party coverage.

Yes

No

Current mileage*

Enter the current mileage of the vehicle here.

Type of lock

Please indicate here what kind of lock you have. Click here for more information on ART locks.

Type of lock

Please indicate here what kind of lock you have. Click here for more information on ART locks.

Type of lock

Please indicate here what kind of lock you have. Click here for more information on ART locks.

Type of alarm*

Please indicate here what type of alarm is on the vehicle. Click here for more information on alarm systems.

Construction of camper*

Factory Building

Own construction

Is there an appraisal report available?*

Yes

No

Date of valuation

Is there a vehicle for daily use?*

Yes

No

Make and type of vehicle daily use*

License plate vehicle daily use*

Additional coverages

It is possible to extend the insurance with the coverages listed below. Click here for more info on additional coverages.

Accidental occupant insurance

(€2.73 per month)

Yes

No

Accidental rider insurance

(€2.00 per month)

Yes

No

Legal Aid

(€5.50 per month)

Yes

No

Occupant damage insurance

(€4.50 per month)

Yes

No

Acceptance Questions

These questions are for both the driver, policyholder, vehicle owner or other interested party.

In the last 8 years, has the applicant, or any other interested party in this insurance, been in contact with the police or the judicial authorities as a suspect or in execution of a (criminal) measure imposed, in connection with: Unlawfully obtained or to be obtained advantage such as theft, embezzlement, fraud, swindling, forgery or attempt(s) to do so; Unlawful harm to others such as destruction or damage, assault, extortion and extortion, threat or any other crime against personal freedom or against life or attempt(s) to do so; Violation of the Weapons and Ammunition Act, the Opium Act or the Economic Offenses Act?*

No

Yes

Has the applicant, or any other interested party in this insurance, had any insurance cancelled, declined or offered on restrictive or aggravating terms in the last 8 years?*

No

Yes

Does the regular driver hold a license valid in the Netherlands to drive the insured motor vehicle?*

Yes

No

Has the applicant, regular driver or holder of the registration certificate, been disqualified (conditionally) from driving in the past 8 years?*

No

Yes

How much motor vehicle damage has the applicant, regular driver or license plate holder suffered/incurred in the past 5 years, other than windshield damage ?*

Is your ability to drive affected by a disability, illness or use of medication?*

No

Yes

Customer type*

Private

Business

Company name*

Name*

Salutation First name Insert Surname

Email*

Enter email address Confirm email address

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Enter your zip code and house number*

Street name*

Zip code*

Enter the zip code of your residential address here.

House Number*

House number addition

For example: A or 3 high

Residence

Phone number*

Enter your landline or cell phone number here.

Branch*

Other communication

Change vehicle

Old vehicle data

New vehicle data

Desired coverage and effective date

Additional coverages

Acceptance Questions

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