Request form My electric car

✔ Sustainability is important to us – attractive insurance premiums especially for electric vehicles!

✔ Comprehensive insurance coverage similar to My Car

✔ Coverage for indirect lightning strike by charging the vehicle from Package Plus

✔ Breakdown Assistance in case your battery is about to die

Form sent successfully.

Apologies, we are currently unable to handle your request. Please try again.

Warning - The E-Mail Address configured for this form is either unverified or invalid. Please verify the E-Mail Address and try again later.

A verification E-Mail was sent to the following E-Mail addresses:

Kindly check the corresponding inbox for a verification E-Mail and verify it.

Warning - Please add an email field in the form to proceed without any errors

Warning - The page URL seems to be incorrect. Kindly check the URL and try again.

Last name

Error Mandatory field

First name

Error Mandatory field

Zip code

Error Mandatory field

E-Mail

Error Mandatory field

Phone

Error Mandatory field

Your request (optional)

Error Mandatory field

Click here to find our information on data protaction.

Warning! Your mobileNumber field is not set up with the right component. Please use Textfield component with phone number validation, in order to avoid any errors when transporting data to Adobe Campaign

See our privacy statement

Enter the text from the box. 60 seconds remaining. Can't read the text?

Enter Label

Error Mandatory field

Unfortunately an error occured. Please try again.

Sorry, that does not match the text in the box. Please try again.

Warning - This form has 100 fields, which is over the maximum allowed field count: 75. Form submissions will fail if this page is published.

Warning - The technical field name is duplicated in more than one location. This will cause information loss when delivering the form submission. Please remove the duplicated field or rename its field name.

Warning! Please upload a file with the correct file type to proceed.