Submit vehicle change online to Alpina.

Old vehicle data

Enter the details of the old vehicle here.

Brand and type*

Registration mark*

Please enter the registration number here.

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Registration mark*

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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 commuter) travel

Business

Lease car

Yes

No

Type of vehicle*

Select the type of vehicle you wish to insure here.

Date of birth of youngest driver*

Type of scooter/moped

Brand and type*

Registration mark*

Please enter the registration number here.

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Registration mark*

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Brand

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Model

Chassis number/Measure code*

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

Select the desired coverage here. Click here for more information on possible coverages.

Third-party liability (WA)

WA + Limited Casco

WA + Casco (All-Risk)

Desired coverage*

Select the desired coverage here.

Third-party liability (WA)

WA + Theft

WA + Theft and Fire

WA + Theft, Fire and Collision

Daily value*

Enter the current value of the vehicle.

Catalogue value/New value*

Number of kilometres per year*

Please indicate here how many kilometres per year you are going to drive with the vehicle.

Insure older vehicle?*

If the old vehicle has not yet been sold, you can insure it for a maximum of 14 days on a third-party insurance policy.

Yes

No

Current mileage*

Please enter the current mileage of the vehicle.

Type of lock

Indicate here what kind of lock you have. Click here for more information about ART locks.

Type of lock

Indicate here what kind of lock you have. Click here for more information about ART locks.

Type of lock

Indicate here what kind of lock you have. Click here for more information about ART locks.

Type of alarm*

Indicate here what kind of alarm is installed on the vehicle. Click here for more information on alarm systems.

Construction of the motor home*

Factory building

Own construction

Is there a valuation report?*

Yes

No

Date of valuation

Is there a vehicle for daily use?*

Yes

No

Make and type of vehicle daily use*

Vehicle registration number daily use*

Supplementary coverages

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

Accidental occupant insurance

(€2.73 per month)

Yes

No

Accident rider insurance

(€2.00 per month)

Yes

No

Legal aid

(€5.50 per month)

Yes

No

Passenger indemnity insurance

(€4.50 per month)

Yes

No

Acceptance questions

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

Has the applicant, or any other person interested in this insurance, been in contact with the police or with the judicial authorities during the last eight years, as a suspect or in execution of a (criminal) measure imposed, in connection with Unlawful obtaining or prospective obtaining of an advantage such as theft, embezzlement, fraud, forgery or attempt(s) to that end; Unlawful damaging of others such as destruction or damage, assault, extortion and extortion, threatening or another crime against personal freedom or against life or attempt(s) to that end; Violation of the Weapons and Ammunition Act, the Opium Act or the Economic Offences Act?*

No

Yes

Has the applicant, or any other person concerned with this insurance, had any insurance cancelled, refused or offered on restrictive or aggravated terms in the last 8 years?*

No

Yes

Is the regular driver in possession of a driving licence valid in the Netherlands for driving the insured motor vehicle?*

Yes

No

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

No

Yes

How much damage with a motor vehicle has the applicant, the regular driver or the holder of the registration certificate suffered/caused in the past 5 years, other than damage to the windscreen?*

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

No

Yes

Type of customer*

Private

Business

Company name*

Name*

Salutation First name Insertion Surname

E-mail*

Enter e-mail address Confirm e-mail address

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Enter your zip code and house number*

Street name*

Postcode*

Please enter the postcode of your residential address.

House number*

House number addition

For example: A or 3 high

Town/City

Phone number*

Please enter your landline or mobile phone number.

Location*

Other communication

Change vehicle

Old vehicle data

New vehicle data

Desired coverage and effective date

Supplementary coverages

Acceptance questions

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