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KBC Woluwe Gossuin & Blanchart

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Quotation Car

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Policyholder
Name*
First Last
Address*
Street Address City ZIP / Postal Code
Email*
Telephone*

Your contract type
*
- First contract (in own name)
- Replacement vehicle (in existing contract of KBC)
- Acquisition contract (other company)
- Additional vehicle

Which policies have you already with KBC?
- Fire (> 180 € / year)
- Family insurance
- Accident insurance

Vehicle specifications
Type of vehicle*
Brand
Type
Capacity of engine (CC)
Power (KW)
Fuel*
Date 1st commissioning
DD slash MM slash YYYY
License plate
Chassis number

Use of vehicle
- < 10.000 km/year
- Pulls trailer (> 750 kg)
- Daily traffic
- Professional use
- Leasing/Renting-contract

Drivers
Frequent drivers
(each name + date of birth + date of license)

Ensuring safeguards
- Civil liability
- Judicial assistance
- Full omnium
- Partial omnium
- Assistance (VAB, replacement vehicle,...)
- Accident insurance (driver)

In case to ensure Full Omnium
Invoice price
(incl. VAT) without reducing of a possible takeover price!
Invoice date
DD slash MM slash YYYY
Exemption
Exemption theft
VAT recovery
(for self-employed)

In case you currently have no car insurance at our office
Frequent driver?
With which company?
How many years have you been insured as a frequent driver?
Number of accidents in error?
(last five years)
Number of accidents in right?
(last five years)
Current Bonus Malus?

Extra
Other remarks

News

Storm op komst? Zo bescherm je je woning (en jezelf)
May 05, 2026
Your life is always on the move. At KBC Insurance, we move with you.
Apr 22, 2026
You can do more with Kate Coins
Apr 03, 2026
Best wishes
Dec 17, 2025
KBC helps you look after your employees
Dec 04, 2025
We’re also here for daredevils
Nov 19, 2025
What insurance do you need for a home?
Nov 03, 2025
Back to school: are your insurances up to date?
Aug 29, 2025
Together we make your company more energy efficient
Jun 19, 2025
Protect your staff with KBC’s occupational accident insurance
Apr 17, 2025

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Recent Posts

Storm op komst? Zo bescherm je je woning (en jezelf) Tuesday May 5th, 2026

Damage

Information
Documents
How to fill in EAS?

Connected agent, Company number: 0898.411.228 of KBC Verzekeringen nv, Professor Roger Van Overstraetenplein 2, 3000 Leuven, Belgium VAT BE 0403.552.563, RPR Leuven.

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