younGo motorcycle and scooter insurance

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Title *

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First name *

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Last name *

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Street *

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No. *

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Postcode *

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Town/City *

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Nationality *

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Date of birth *

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Mobile *

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Email *

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Date of contract commencement *

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Upload your vehicle registration document as a file or smartphone photo: *

File upload

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Do you already have a licence plate for the vehicle?

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Canton

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Number

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I confirm that my driving licence has not been withdrawn in the past five years.

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I confirm that, during the past five years, neither Baloise nor any other company has refused my application for insurance, terminated a contract or imposed special conditions on the basis of claims cases.

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Have you made any claims in the past five years? *

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Number of liability claims *

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Unfortunately, we are not able to insure you. We will gladly assist you by telephone: 00800 24 800 800

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Number of collision insurance claims *

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Unfortunately, we are not able to insure you. We will gladly assist you by telephone: 00800 24 800 800

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Number of other claims *

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Unfortunately, we are not able to insure you. We will gladly assist you by telephone: 00800 24 800 800

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How were you alerted to our offer? *

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Please state the name: *

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Comments

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By submitting the form, I declare that I have answered all the questions truthfully and completely, that I have read the Product Information and that I agree to the general Terms and Conditions (PDF).

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By submitting the form, I declare that I have read the Privacy Policy (German only) and that I agree to it.

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By submitting this form, I agree to the additional provisions for insurance contracts subjects to the law of Liechtenstein (German only).

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By submitting this form, I agree to insurance transactions being conducted electronically and to paper documents being dispensed with. Upon conclusion of the contract, I will obtain automatic access to the myBaloise customer portal.

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