Vanguard Assurance

COMPANY LIMITED

Select Proposer Type Agent Broker Personal Corporate

Select ID type Drivers License Ghana Card Passport Voters Id

Type of cover required

Comprehensive

Third Party Fire & Theft

Third Party

Vehicle State

New

Used

Please provide images of the vehicle

Purpose Of Vehicle

Private

Commercial

Has the vehicle been altered to carry heavier loads other than specified by manufacturer?

Yes

No

Have you or any other person who to your knowledge who would operate this vehicle:

Have any physical defect or infirmity

Yes     No

Been prosecuted in court

Yes     No

Been convicted for a motor offence

Yes     No

Please provide details on any accidents or loss during the past three years:

Are you entitled to a "No Claim Discount?" from previous insurance? Evidence will be required.

Yes

No

Has any previous request for insurance by you been:

Declined

Yes     No

Canceled

Yes     No

Had special conditions imposed

Yes     No

Select Preferred Branch Accra Main Achimota Adenta Aflao Bolgatanga Cape Coast Dambai Damongo Dansoman East Legon Goaso Head Office Ho Kumasi Nalerugu Obuasi Sefwi Wiawso Spintex Sunyani Swedru Takoradi Tamale Tarkwa Techiman Tema Tema Habour Wa West Hills

Policy Duration * 1 Month 3 Months 6 Months 12 Months

Currency *

Cedi (₵)

Dollar (us) ($)

Pounds (br) (£)