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• Company Name*
• Company Description*
• Name*
• Email*
• Line of Business*
  • Shared Micro-Mobility
  • Delivery
  • Gig Economy
• Insurance product*
  • Third Party Liability
  • Personal Accidents
  • Product Liability
• Fleet Size/Number of Users*
• Monthly Projected Hours Per User*
• Monthly Projected Kilometers Per User*
• Vehicle Type
  • Electric Scooter
  • Electric Bike
  • Bicycle
  • Other
• other*
• Territories of Activity*
• Number of Insurance Claims in the Past 3 Years*
• Current Insurance Terms and Conditions (products and covers)*
• Insurance Product*
  • Third Party Liability
  • Personal Accidents
  • Professional Indemnity
  • Product Liability
• Profession Type*
• Yearly Projected Income Per User*
• Territories of Activity*
• Number of Insurance Claims in the Past 3 Years*
• Current Insurance Terms and Conditions (products and covers)*
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