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Temporary Substitution Car Form

If your insurance has been arranged with Zurich by a broker, please contact your broker to amend your policy details.

For direct Zurich customers please note that submission of this form does not automatically change the cover under your policy. One of our team will contact you shortly to confirm that change. Alterations can only be made by the policyholder, their spouse/partner or a garage/intermediary acting on the policyholder's behalf.

Policy Number:*

e.g. 01 PMV 1234567

Full name:*

Email-address:*

Telephone:*

Existing Vehicle Registration No:*

Change(s) to be effective from:*

DD/MM/YYYY

Time:*

HH:MM

Date that Cover is to revert to the Existing Vehicle:*

DD/MM/YYYY

Time:*

HH:MM

Reason for the Temporary Change of Vehicle:*

Note: If cover in respect of the Temporary Vehicle is required for more than 30 days then please contact us directly on 1890 400 300. It is important that you provide the complete details in relation to the vehicle. All information required should be available on the Vehicle Registration Certificate.

Temporary Vehicle Registration No:*

Temporary Vehicle Make:*

Temporary Vehicle Model:*

Temporary Vehicle Estimated Value (€):*

Temporary Vehicle Engine Size / Year of Manufacture:*

Fuel type:*

PetrolDieselTurbo Diesel

Note: We asume that the Temporary Vehicle is a PRIVATE CAR which has not been altered/modified from the manufacturer's standard specification and that it will not be used in connection with any business unless said usage is permitted under the terms of your policy.

* Required fields