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Driver Information
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| John Doe | Gender: Male | Do you own or rent: Own Current U.S. license status: Current Age license first issued in US: 16 Rate your own credit: Excellent |
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| 8895 SW 107th Avenue MIAMI FL 33173 |
DOB: 11/27/1977 Marital status: Single GPA: 3.5 |
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| Driver's License State: FL | Driver's License Number: A146-232-99-084-0 | SSN#: 000-00-0000 | |||||||||
| In the last three (3) years, have you had: |
In the last seven (7) years, have you had: |
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| Accidents (at fault or not): No | License suspensions: No | ||||||||||
| Moving violations or tickets: No | Requirement to file an SR-22: No | ||||||||||
| Insurance claims of any kind: No | |||||||||||
| How many miles is your daily commute: 1-3 | How many miles a year do you drive: 0 - 5000 | ||||||||||
Vehicles Information |
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| Year | 2004 |
| Make | BMW |
| Model | 325CI |
| Primary vehicle use | Personal |
| Zip code where the vehicle is primarily kept | 33173 |
| Own or lease | Own and make payments |
| Is your car equipped with airbags? | Airbag on driver side only |
| Equipped with factory installed anti-lock braking system | No |
| Does your vehicle have a security system/alarm | No Alarm |
| Vehicle Identification Number | N/A |
Coverage |
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| Quote # A-HJ-12202005-1 | Quote date 2005-12-20 16:23:32 |
| Do you currently have auto insurance? | No |
| Coverage desired? | Full Coverage |
| Bodily injury liability limits | 10/20 |
| Property Damage Coverage | 10,000 |
| Uninsured Motorist Bodily Injury? | 10/20 |
| Your Medical Coverage | 0 |
| Towing Coverage | Yes |
| Rental Reimbursement | Yes |
| Comprehensive Deductible | 500 |
| Collision Deductible | 500 |