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* Pre-contractual duty of disclosure

You must answer all questions contained in this application form honestly and with reasonable care. Failure to do so may result in your policy being cancelled or we may refuse to deal with any claims or reduce the amount of a claim payment, as detailed under the Impact of Misrepresentation section, which you should read carefully.

The answers you provide are the basis upon which an insurance cover quotation will be offered or refused.

Impact of Misrepresentation Section. Please read this section carefully.

The Impact of Misrepresentation by you, is as follows:

(a) Innocent Misrepresentation:
Where you have answered all questions in your application form honestly and with reasonable care but where you made an innocent misrepresentation (that is, one that is neither negligent nor fraudulent) we will pay any covered claim event subject to the terms and conditions of your policy.

(b) Negligent Misrepresentation: If you make a negligent misrepresentation or fail to take reasonable care in completing your application form your cover may not fully operate and in the event of a claim, we will exercise one of the following remedies:
- (a) If knowing the full details, we would not have entered into the insurance contract, we may avoid the contract, refuse all claims and return any premiums paid by you.
- (b) If we would have entered into the insurance contract, but on different terms (excluding terms relating to the premium), the contract may be treated as if it had been entered into on those terms.
- (c) If we would have entered into the insurance contract but have charged a higher premium, we may reduce proportionately the amount to be paid on your claim.
- (d) Where there is no outstanding claim under the insurance contract, we may either:
  (i) give notice to you that in the event of a claim we will exercise the remedies in paragraphs (a) to (c), or
  (ii) terminate the contract by giving reasonable notice to you.

(c) Fraudulent Misrepresentation: If you make a fraudulent misrepresentation or where any conduct by you involves fraud of any kind, we shall be entitled to avoid the contract of insurance and refuse any claims.

1. Your Details
Edit

Please enter your details In all the fields below
Please provide your name as it appears on your driving licence.

Title

* Title Required

First name

* Forename Required * Please enter your full forename

Surname

* Surname Required * Please enter your full surname

Email Address

* Please enter your e-mail address * Please enter a valid e-mail address

Contact number

* Contact Number (Preferably Mobile) * Only numbers allowed for a contact number.

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2. Your Information
Edit

Back to Address Search

Please enter your address below:

Address 1

* What is the first line of your address * What is the first line of your address

Address 2

*Address *Address

Address 3 (Optional)

*Address

County

* Please select your county * Please select your county

Sub Area of County

* Please select your SubArea

Confirm Address

Your Address/Eircode
Cannot find address?

Sorry the Address lookup is not available at the moment. Please select your county below as an alternative.

Address

Is this the correct address?

Yes

Is this the correct address?

Yes Confirm

No, Try Again

No, Use Address Entered

* Please confirm this address

Try Again

Continue Anyway

Address Successfully Added.

Change Address

Address Successfully Added.

Change Address

Were you born in Republic of Ireland or UK?

* Were you born in ROI or UK?

Date of Birth

* date of birth day!

* date of birth Month!

* date of birth Year!

Sex

Male
Female

*Sex Required

Marital status

* Marital Status

Employment status

* Employment Status

Occupation

* Cannot enter special characters * Occupation

Previous occupation

* What was your Occupation

Date employment ended

* Month Employment Ended

* Year Employment Ended

Student type

* Student Type

What type of driving licence do you hold?

* Licence Type Required

Years licence held

* How long have you held your licence

Continue

3. Insurance Details
Edit

Please enter how many years no claims you have below.

Your driving experience

* Please Select Your Driving Experience

Will you use this car to commute to work?

Will you use the vehicle to commute to work?

Select 'Yes' only if you are commuting to one permanent place of work. If you are travelling to a number of locations then you will need to answer 'Yes' to limited business as well.

* Will you use the vehicle to commute to work?

Will you use this car in connection with your work?

Will you use the vehicle for limited Business use?

Most People will use their vehicle to commute to one permanent place of work. If you travel between a number of locations or use the vehicle in connection with your work, e.g to claim mileage for a training course then you will require class 1 - limited business use. If you use the vehicle for YOUR business as opposed to in connection with your business then you may require increased cover.

Will you use the vehicle for limited Business use?

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4. Kilometre Details
Edit

Boxymo is a kilometres based policy. Each month you will have the chance to earn 'Reward kilometres' based on your driving behaviour and the number of annual policy miles selected. Taking this into consideration, select the number of kilometres that you think you will require for the year.

You can purchase "Top Up" kilometres if you run out but we would recommend purchasing the correct number of kilometres at inception as this will work out cheaper.

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4. Vehicle Details
Edit

Please add your Vehicle.

Please Add Your Vehicle:

Add Vehicle

Do you know the vehicle's registration

*Required

Vehicle registration

Find Car * Vehicle registration required * Registration Not Found, please check you've entered it correctly. You may have to select it manually if it does not appear on our records

Is this your vehicle?

* Please indicate if the vehicle above is yours?

Please Select Vehicle Manually.

Make:

* What make is the vehicle?

Model:

* What Model is the vehicle?

Fuel Type:

* What fuel does the vehicle use?

Year Made:

* What year was the vehicle made?

Transmission:

* What is the transmisson of the vehicle?

Vehicle:

* Please choose your vehicle.

When did you purchase the vehicle?

* date of purchase day!

* date of purchase Month!

* date of purchase Year!

What is your current estimated car value?

* What is the current value of the vehicle?

Has a tracking device been fitted to this car?

* Has a tracking device been fitted to this car?

How many kilometres will this car travel over the next 12 months?

* What Annual Mileage will you do?

Has this car been modified or adapted in any way?

* Is this vehicle modified?

Cancel

Save Vehicle

5. Additional Drivers No Additional Drivers - Add Driver +
Edit

You may add up to 2 additional drivers.

You may add up to 2 additional drivers

Would you like to add a driver to this policy? Add Driver

Maximum Drivers Reached

You have reached the maximum amount of drivers allowed for this policy.

Driver Details

Enter driver details

Title

* Title Required

First Name

* Forename Required * Please enter your full forename

Surname

* Surname Required * Please enter your full surname

Sex

Male
Female

* Driver Sex Required

Date of Birth

* Day

* Month

* Year

How long has this driver been a permanent resident in Republic of Ireland?

* How long have you been resident in Ireland and/or the UK?

What is their employment status?

* Employment Status

What is their Occupation?

* What is your occupation

* Cannot enter special characters * Occupation

Previous Occupation

* What was your Occupation

Date Employment Ended

* Month Employment Ended

* Year Employment Ended

What type of driving licence do they hold?

* Licence Type

Years licence held

* How many years have they held their licence

What is their Relationship to YOU the proposer?

* How are they related to you?

Does spouse have their own vehicle

* Does spouse have their own vehicle?

Will the driver use the vehicle to commute to work

Will the driver use the car to commute to work?

Select 'Yes' only if you are commuting to one permanent place of work. If you are travelling to a number of locations then you will need to answer 'Yes' to limited business as well.

* Will the driver use the vehicle to commute to work

Will they use the car in connection with their work?

Will you use the vehicle for limited Business use?

* Will the driver use it for limited business use?

Cancel

Save Driver

Continue

6. Claims
Edit

Have you had any claims or accidents in the last 5 years regardless of blame?

* Claims

Incident date

* Day Incident Occurred

* Month Incident Occurred

* Year Incident Occurred

Incident type

* Type Of Claim?

Is the claim now fully settled?

* Is the claim settled?

What happened

* What Happened

Were you at fault?

* At fault?

Was there a personal claim against you?

* Personal Injury Claim Against You?

Total Third Party claim costs

* Personal Injury Claim Against You? * Numbers Only

Own damage claim costs

* How much did you claim for your own damages? * Numbers Only

Cancel

Save Claim

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7. Penalty Points
Edit

Do you have any active or pending penalty points on your licence?

* Penalty points

Type of offence

* Type of offence

On what date were the penalty points received?

* Day Offence Occurred

* Month Offence Occurred

* Year Offence Occurred

Number of penalty points for this offence?

* Number of penalty points received

Were these penalty points applied due to a judgement in a court of law?

* Applied due to a judgement in a court of law

Cancel

Save Penalty Points

Continue

8. Cover Date
Edit

Please enter the date you would like your policy to start.

Policy Start Date

* Cover day!

* Cover Month!

* Cover Year!

Promo Code

Please confirm that you have READ and ACCEPT the Pre-contractual Duty of Disclosure, Eligibility Criteria & Terms of Business. The Terms of Business is available to view along with all other standard policy documentation by clicking HERE

* Please confirm that you have read and accepted the above

Eligibility Criteria

We require certain eligibility criteria about you and your car to be met in order to provide you with a quote. If you decide to take a policy with us, you will be required to explicitly confirm this eligibility criteria is met.

About you

You and or spouse/partner are the main drivers of the vehicle
You or any driver will not use the vehicle for soliciting orders (deliveries) and/or to carry tools, goods or samples in connection with your work
You or any named driver have never been convicted of any offence or have any conviction pending (this includes motoring and/or any non-motoring criminal offences)
You or any named driver have not had any driving disqualifications in the last 10 years
You or any named driver have never been refused car insurance, or had any car insurance policy declared void or cancelled by an insurer in last 7 years
You or any named driver have never had an increased excess or reduced level of cover imposed on a policy by an insurer In the last 7 years
You or any named driver do not have any medical conditions that impair their ability to drive

About your vehicle

The vehicle is registered in Ireland
The vehicle Is owned by and registered in either your name or your spouse/partner
The vehicle is a private car and is taxed privately
The vehicle has a valid NCT

Your insurance history

Your no claims bonus was earned in Ireland/UK or EEA
Your No Claims Discount is not in use on any other active policy (you earn the no-claims discount on each car separately if you insure more than one car and the same No Claim discount cannot be in use at the same time on more than one policy)

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AIG Europe Limited (AEL) is undertaking a restructure as part of its plans for the UK leaving the European Union and intends to transfer its European business to AIG Europe S.A. (AIG Europe) which is expected to take effect on 1 December 2018. AIG Europe is a member of the same group of companies as AEL. As a result of the restructure, your policy will transfer to AIG Europe but this will have no effect on the cover provided under the policy. Please Click Here to view information relating to the proposed transfer and the rights you have.

Duty Of Disclosure

It is your responsibility to provide complete and accurate information to insurers when you take out a policy, throughout the life of your policy and when you renew the insurance. Failure to disclose information pertaining to your insurance, or any inaccuracies in information provided, could result in your insurance policy being invalid or cover not operating fully.

It is important that you ensure that all statements you make on proposal forms, claims forms and other documents, are full and accurate. If a form is completed on your behalf, you should check that the answers shown to any questions are true and accurate.