HomeProductsMotorMarineAviationFireBondEngineeringGeneral AccidentWorkmen CompensationSpecial ProductsClaimsAboutOur StoryInnovationBoard of DirectorsManagementSocial ResponsibilityContactFind an AgentSign In/Up Get Quote Motor Insurance Proposal Form A. DETAILS OF THE PROPOSERFull name of ProposerPostal AddressDigital AddressOccupation/ProfessionID Type & No:TIN NoDate Of Birth/IncorporationTelephone No:Mobile NoFaxEmailFull Name of Vehicle Owner B. TYPE OF COVER REQUIREDComprehensiveComprehensive (Telematics)Third Party Fire and TheftThird Party OnlyC. VEHICLES DETAILSNewOldD. POLICY CURRENCYCediDollarEuroPoundVehicle Reg. NoMake & Model of VehicleCubic CapacityType of Body and ColorYear of MakeYear of Reg.Seating Capacity(Inc. Driver)Sum Insurred(Inc. Accessories)Type & Value of AccessoriesCost of VehicleMileageEngine NumberChasis NumberTPPD LimitE . VEHICLE USAGEFor what purpose would the vehicle be used?PrivateCommercialIf Commercial, please specifyOwn Goods CarryingGeneral CartagePassenger CarryingSpecial TypeHas the vehicle been adapted or altered to carry loads heavier than that stated in the manufacturers’ specification?YesNoHas the vehicle been adapted or altered to improve its value beyond the going market replacement cost? If yes, specifyF. INSURANCE HISTORY OF PROPOSERGive particulars of any motor accident or loss during the last three yearsIs there any other insurance on the vehicle? If yes, state the insurer(s)Are you entitled to a “No Claim Discount” from your previous insurer(s)? If so, provide evidence.Has any previous request for insurance by you been: Declined? Cancelled? or had special terms imposed?G. OTHERSHave you or has any other person who to your knowledge would drive this vehicle: a. Any physical defector infirmity? b. Any prosecution against you in court? c. Ever been convicted of any motor offense?Do you and all persons who to your knowledge would drive this vehicle, have valid driving licenses?YesNoIs any person or institution financially interested in the vehicle? If yes, specifyH. PERIOD OF COVERCommencing FromTo
