AXA Motor Insurance Quote

AXA Insurance

Priority: iWoman.ie - Private Car Insurance Quote

Request a Quote

Non-Disclosure Warning: You are under a duty to disclose all facts likely to influence the assessment and acceptance of your proposal. AXA may cancel your policy, declare the contract to be void and refuse to pay any claim under the policy in addition to any other rights AXA may have under the policy. It is in your own interest to mention such facts. If you are in any doubt whether certain facts are materials, please ask you local AXA Insurance office.

About You:

Title
Full Name
Full Postal Address
Full Work Address
Telephone (Daytime)
Telephone (Evening)
Email Address
Date of Birth	Day Month Year

Occupation (including part time occupations):
Will you or anyone who will drive the car use it for Business purposes? If so, please give details:
Number of claim free driving years in your own name:	From Year: To Year:
Or Number of claim free driving years as a named driver:	From Year: To Year:
Name of previous Insurance Company:
Please select which type of licence you hold?
Renewal date of policy:	Day Month Year
Are you a Total Abstainer from alcoholic drink?	Yes No

About Your Car
Make & Model : e.g. Ford Escort 1.3L
Engine Capacity (cc), e.g. 1296:
What is year of the car?
What is the car registration?
What is the value of your car?

Additional drivers:

Before completing this section you must ensure that you have any drivers consent to our use and sharing of any personal/sensitive data.

Please complete the following details about your additional drivers:

Driver No. 2
Full name:
Date of Birth:	Day Month Year
Occupation:
Relationship to you e.g. Spouse
What kind of licence do they have?

Driver No. 3
Full name:
Date of Birth:	Day Month Year
Occupation:
Relationship to you e.g. Spouse
What kind of licence do they have?

Driver No. 4
Full name:
Date of Birth:	Day Month Year
Occupation:
Relationship to you e.g. Spouse
What kind of licence do they have?

Cover required: Please select which type of cover you need:

Driving License
Do you or any one else who may drive
(a) Have any medial condition, impairment or mental or physical disability that may affect your ability to drive safely at all times?	Yes No
(b) Have a dependency on or regularly abuse any substance notifiable on a driving licence application?	Yes No
If yes please give full details
Previous Insurance
Have you or anyone who may drive had a proposal for motor insurance refused or a motor insurance policy cancelled or been disqualified from driving?	Yes No

Please select any of these additional cover options for an extra premium:

	Breakdown Service
	Extra Benefits (including Medical Expenses, Windscreen Cover, Legal Expenses and Personal Belongings)
	Personal Accident
	Drivers Fatal Accident
	Protected No Claims Discount

Have you or any person who will drive the vehicle to your knowledge:
Been disqualified from driving or convicted of any offence in connection with any motor vehicle within the last 10 years or is any prosecution pending or had any Penalty Points applied in the last 10 years?

	No. of Points	Type of Offence (please give full details)	Date of Points Application (DD/MM/YY)
Driver No.1 (Self)
Driver No.2
Driver No.3
Driver No.4

Previous claims in the last 5 years:
Have you or anyone who will be driving your car had any accident/loss or claim in the last 5 years?	Yes No
Date of Claim:	Day Month Year
Full description of Accident/Claim:
What is the amount of payments made to date?
Is the claim settled?	Yes No

If there are any other details you feel are relevant, please fill in the following section:

Thank you for taking the time to complete this quotation, we will reply to you by E-mail with a quotation.

Data Protection Notice

Please tick here if you wish us to post a quotation out to you.

Please note that Cover will not commence until the Company has accepted the details you have provided and agreed cover.

You should ensure that the details supplied to us are true to the best of your knowledge and belief.

AXA Insurance Limited is regulated by the Irish Financial Services Regulatory Authority.

Breakdown Assistance

If your car breaks down, help is just a phone call away. Phone our emergency centre at any time and we will arrange to have a professional motor trade person sent to your location. They will try to get you going again, but if they can't they will make suitable arrangements to either get you home or onward to your destination, and your car to a repairer.

For only €49.98 this service will operate 24 hours a day and 365 days a year.

Terms and conditions apply.

Personal Accident Policy

For as little as €15.30 you can buy cover that provides €10000 in the event of your death or disablement following a motor accident. We will also cover you for €67.49 per week if you are temporarily unable to work as a result of a motor accident.

Terms and conditions apply.

Driver's Fatal Accident Policy

For as little as €15.30 you can buy cover that provides €19000 if the driver of your car dies in an accident involving your car.

Extra Benefits

Our Extra Benefits Package is designed to give you worry-free motoring. The entire package costs remarkably little, considering the benefits it includes. For € 24.76, € 27.93 if you're not comprehensively insured, the Extra Benefits Package gives you all these benefits, without loss of your No Claims Discount.

Windscreen Replacement:
Entitles you to have a replacement fitted without fuss or form filling

Car Hire Expenses:
€ 20.32 per day, up to a maximum of 35 days towards the hire of a replacement car while your own car is off the road (due to accident, fire or theft).

Compensation for theft of Personal Belongings:
Up to € 159 compensation for theft of your personal belongings from your car.

Towing Costs:
If you have to arrange to have your car towed after an accident, we will contribute up to € 45 towards receipted towing costs.

Additional Legal Fees:
Up to € 1,270 for legal fees towards certain road traffic offences.

Hospital Benefits:
€ 127 per week, up to a limit of twenty weeks, to offset expenses of hospitalisation.

Death Benefit:
€ 2,540 which goes to your next-of-kin in the event of a fatal accident, while driving the insured car, regardless of any other compensation which may arise.

Fire Brigade and replacement lock charges:
We will pay any Fire Brigade call out charges you incur (up to a limit of € 1270) in respect of loss or damage to your vehicle. Similarly, if your car keys are stolen, we will pay up to € 508 toward replacing locks or alarms.

Protected No Claims Discount (NCD)

A no claims discount can take years to earn, yet minutes to loose. For an additional premium, (approx.12.5% of your premium) we can now protect your third party and accidental damage discounts against one claim in a 3 year period.

This discount protects your NCD against the first Third Party (TP) or Accidental Damage (AD) claim.

You must be claim free for the past 3 years.

You must be earning a 70% Third Party and 40% Accidental Damage No Claims Discount.

Registered in Ireland number 136155
For your own security and to help us improve our service, we may record or monitor phone calls.
Terms & Conditions apply. AXA Insurance Limited is regulated by the Irish Financial Services Regulatory Authority.